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
Keywords:
acute promyelocytic leukemia, alltrans retinoic acid syndrome, hepatosplenic fungal infection, leucemia acuta promielocitica, sindrome da acido trans-retinoico, infezioni fungine epatosplenicheAbstract
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.
Downloads
Published
Issue
Section
License
OPEN ACCESS
All the articles of the European Journal of Oncology and Environmental Health are published with open access under the CC-BY Creative Commons attribution license (the current version is CC-BY, version 4.0 http://creativecommons.org/licenses/by/4.0/). This means that the author(s) retain copyright, but the content is free to download, distribute and adapt for commercial or non-commercial purposes, given appropriate attribution to the original article.
The articles in the previous edition of the Journal (European Journal of Oncology) are made available online with open access under the CC-BY Creative Commons attribution license (the current version is CC-BY, version 4.0 http://creativecommons.org/licenses/by/4.0/).
Upon submission, author(s) grant the Journal the license to publish their original unpublished work within one year, and the non exclusive right to display, store, copy and reuse the content. The CC-BY Creative Commons attribution license enables anyone to use the publication freely, given appropriate attribution to the author(s) and citing the Journal as the original publisher. The CC-BY Creative Commons attribution license does not apply to third-party materials that display a copyright notice to prohibit copying. Unless the third-party content is also subject to a CC-BY Creative Commons attribution license, or an equally permissive license, the author(s) must comply with any third-party copyright notices.