Leukemia/Leucemia (C92.4) - Hepatosplenic fungal infection during induction remission therapy for acute promyelocytic leukemia: a case report / Le infezioni epatospleniche fungine durante trattamento di induzione della remissione per leucemia acuta promielocitica: un caso clinico
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Hepatosplenic fungal infections (HSF) are the primary type of invasive fungal infections (IFI) identified among patients with acute leukemia. We describe a case of HSF acquired during remission induction for acute promyelocytic leukemia (APL) initially misdiagnosed as alltrans retinoic acid syndrome. Computed tomography (CT) identified a number of low-density lesions within the liver and spleen. Pathology following splenectomy was positive for fungal spores, indicating a deep-tissue fungal infection. The patient responded well to antifungal therapy and is currently in complete remission. HSF is a rare and life-threatening complication among APL patients undergoing chemotherapy. Rapid diagnosis and effective treatment are crucial to preventing the high mortality rate that accompanies HSF. Examination of tissue following surgical excision is currently an effective approach for the definitive diagnosis of IFI, and a high index of suspicion should be maintained in neutropenic patients.
Le infezioni epatospleniche fungine durante trattamento di induzione della remissione per leucemia acuta promielocitica: un caso clinico
Le infezioni epatospleniche fungine (ISF) rappresentano le infezioni fungine invasive (IFI) primarie riscontrate in pazienti affetti da leucemia acuta. Viene descritto un caso di ISF che si è presentato durante il trattamento di induzione della remissione per leucemia acuta promieolocitica (LAP) inizialmente mis-diagnosticata con la sindrome da acido trans-retinoico. La tomografia computerizzata (TC) evidenziava un numero di lesioni a bassa densità tra il fegato e la milza. L’istopatologia successiva alla splenectomia era positiva per la presenza di spore fungine, a dimostrazione di una infezione fungina a livello tissutale profondo. Il paziente rispondeva bene alla terapia antifungina e attualmente è in completa remissione. La ISF è una rara e pericolosa complicazione riscontrabile tra i pazienti affetti da LAP in trattamento chemioterapico. La diagnosi tempestiva ed un efficace trattamento sono requisiti essenziali per prevenire l’elevato tasso di mortalità che caratterizza le ISF. La valutazione del tessuto ottenuto da asportazione chirurgica rappresenta attualmente l’approccio ottimale per poter effettuare diagnosi di IFI ed è consigliato mantenere un alto livello di attenzione nei pazienti neutropenici.
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