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Orofacial aspergillosis in acute leukemia
Abstract:
The clinicopathologic characteristics of orofacial aspergillosis in thirteen hospitalized patients who developed the infection while receiving chemotherapy for acute leukemia are described. Clinically, the primary sites of infection, in decreasing order of frequency, were the paranasal sinuses, nasal cavity, mouth, and facial skin; the corresponding order for the secondary sites was orbit, nasal cavity, facial skin, and mouth. Pathologically, the fungal lesions in the nasal, oral and sinusoidal cavities were black, ulcerated, and escharotic due as a direct result of tissue destruction by the organism and an indirect result of thrombotic vascular infarction. The orbital lesions were deep red, granulomatous, and productive of proptosis and ectropion. Seven of the thirteen patients had concomitant pulmonary aspergillosis. The orofacial infections were not responsive to antifungal therapy in the absence of remission of the leukemia and restoration of depressed host defenses. In two patients who did achieve remission, the aspergillosis was controlled by the intravenous administration of amphotericin B.
Insights
Orofacial aspergillosis in acute leukemia patients receiving chemotherapy is challenging to treat. Antifungal therapy is ineffective without leukemia remission and restored immune defenses.
Area of Science:
- Medical Mycology
- Hematology
- Oncology
Background:
- Orofacial aspergillosis is a serious opportunistic infection.
- Patients undergoing chemotherapy for acute leukemia are particularly vulnerable.
Purpose of the Study:
- To describe the clinicopathologic characteristics of orofacial aspergillosis.
- To evaluate treatment responses in this patient population.
Main Methods:
- Retrospective case series of thirteen hospitalized patients.
- Analysis of clinical presentation, pathological findings, and treatment outcomes.
Main Results:
- Common sites included paranasal sinuses, nasal cavity, and mouth.
- Lesions were characterized by ulceration, escharotic changes, and vascular infarction.
- Concomitant pulmonary aspergillosis occurred in 7/13 patients.
- Infections were unresponsive to antifungal therapy without leukemia remission.
- Two patients achieved remission and responded to amphotericin B.
Conclusions:
- Orofacial aspergillosis in leukemia patients requires addressing the underlying immunosuppression.
- Successful treatment hinges on achieving leukemia remission and immune reconstitution.
- Amphotericin B may be effective in controlled cases post-remission.