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Aspergillosis in a patient with acute lymphoblastic leukaemia
P M Lashley1, D P Callender, A C Graham
1Department of Paediatrics, Queen Elizabeth Hospital, Barbados.
Abstract:
A case is described of a 3-year-old boy with acute lymphoblastic leukaemia (ALL) who presented initially with aspergillosis of the nasopharynx. Fungal infection with Aspergillus species is not uncommon in immunosuppressed children, but this case is noteworth in that the disease presented at the onset of therapy rather than during the phase of treatment, with maximum immunosuppression following chemotherapy. This type of infection is usually associated with the treatment of acute non-lymphoblastic leukaemias (AML) rather than ALL, and prolonged periods of neutropenia which results from aggressive treatment. This patient responded rapidly to treatment with amphotericin B, coincident with resolution of his neutropenia as the underlying disease was treated, eventually eradicating the fungus.
Insights
A 3-year-old boy with acute lymphoblastic leukaemia (ALL) developed invasive aspergillosis at the start of treatment. This rare presentation, treated successfully with amphotericin B, highlights early fungal infection risks in pediatric leukemia.
Area of Science:
- Pediatric Oncology
- Infectious Diseases
- Hematology
Background:
- Invasive fungal infections, particularly aspergillosis, pose significant risks to immunocompromised pediatric patients.
- Acute lymphoblastic leukemia (ALL) treatment often involves chemotherapy, leading to profound immunosuppression and increased susceptibility to opportunistic infections.
Observation:
- A 3-year-old boy with newly diagnosed ALL presented with nasopharyngeal aspergillosis at the initiation of therapy.
- This presentation occurred prior to the nadir of chemotherapy-induced neutropenia, a less common timing for invasive fungal disease in ALL.
Findings:
- The patient's aspergillosis responded rapidly to intravenous amphotericin B treatment.
- Fungal eradication coincided with the resolution of neutropenia and successful treatment of the underlying ALL.
Implications:
- This case underscores the importance of considering invasive aspergillosis at the earliest stages of leukemia treatment, even before maximal immunosuppression.
- Early diagnosis and prompt antifungal therapy are crucial for managing invasive fungal infections in pediatric leukemia patients.
- The findings suggest a need for vigilance regarding opportunistic infections in pediatric ALL, irrespective of the specific phase of immunosuppression.