Aspergillus fungemia is encountered unfrequently. We present a case report on Aspergillus fumigatus fungemia in a 37-year-old female patient with AMIL (M3).After remission induction therapy (cytarabine, rubomycin and all-trans retinoic acid - ATRA) agranulocytosis and ATRA-syndrome with pulmonary insufficiency developed. ATRA-syndrome was treated with prednisolon (200 mg/d, total dose 1800 mg) and mechanical ventilation. Pulmonary insufficiency resolved, but fever, cough and chest pain persisted. In this period A.fumigatus was cultured from blood. There were typical roentgenological and CT signs of invasive aspergillosis of lungs. A.fumigatus was also isolated from sputum. Aspergillus galactomannan was revealed in serum with Pastorex Aspergillus test. Invasive pulmonary aspergillosis with A.fumigatus fungemia was diagnosed. Treatment with amphotericin B1 mg/kg per day (total dose 3750 mg) was performed, but renal insufficiency developed and AmBisome therapy 3 mg/kg per day (total dose 1000 ring) was provided. After patient's condition improved, she was treated with itraconazole (600-400 mg/d) for 2 10 days. Treatment resulted in complete recovery. There were no adverse effects of AmBisome and itraconazole. The patient receives consolidation therapy of AMIL with all-trans retinoic acid and interferon alfa-2a. Duration of molecular-genetic remission of AIMIL (M3) is 7 months. There was no relapse of invasive aspergillosis in 7 months follow up.
Full conference title:
Trends in Invasive fungal Infections 6, 2001
- TIFI 6th