Concomitant invasive pulmonary aspergillosis and Candida zeylanoides bloodstream infection in an acute myeloblastic leukemia patient

Ion Antohe, Angela Dascalescu, Georgiana Butura, Amalia Merticariu, Catalin Danaila, Karina Bilavski, Mihaela Zlei, Petru Cianga


Current management of acute myeloblastic leukemia (AML) involves induction chemotherapy followed by risk stratified consolidation approaches, consisting of high dose chemotherapy or allogeneic stem cell transplantation. AML patients are at high risk of invasive fungal disease, particularly mold infections, due to the leukemia and chemotherapy related immune deficit. We present an AML patient with prolonged fever and neutropenia after induction therapy, during which she developed concomitant Candida zeylanoides bloodstream infection and invasive pulmonary aspergillosis. The response to Caspofungin and Voriconazole therapy was delayed, and this dictated the surgical management of the remnant pulmonary lesions. A histological confirmation of aspergillosis was thus obtained. Evaluation of host risk factors for invasive fungal disease, prompt scale-up of the diagnosis scheme and initiation of antifungal therapy are mandatory in order to ensure patient survival.


Pulmonary Aspergillosis, Acute Myeloid Leukemia

Full Text:



van Burik JH, Leisenring W, Myerson D, et al. The Effect of Prophylactic Fluconazole on the Clinical Spectrum of Fungal Diseases in Bone Marrow Transplant Recipients with Special Attention to Hepatic Candidiasis. An Autopsy Study of 355 Patients. Medicine 1998; 77(4):246-254.

Lin SJ, Schranz J, Teutsch SM. Aspergillosis Case-Fatality Rate: Systematic Review of the Literature. Clin Infect Dis 2001; 32:358-366.

Rüping MJ, Vehreschild JJ, Cornely OA. Antifungal Treatment Strategies in High Risk Patients. Mycoses 2008; 51(Suppl 2):46-51.

Chelgoum Y, Vey N, Raffoux E, et al. Acute Leukemia during pregnancy. A report on 37 patients and review of the literature. Cancer 2005; 104:110-117.

Liu P, Li B, Yin R, et al. Development and evaluation of ITS- and aflP-based LAMP assays for rapid detection of Aspergillus flavus in food samples. Can J Microbiol. 2014; 60(9):579-84.

Babouee Flury B, Weisser M, Prince Savic S, et al. Performances of two different panfungal PCRs to detect mould DNA in formalin-fixed paraffin-embedded tissue: what are the limiting factors? BMC Infectious Diseases, 2014; 14:692.

Liss B, Vehreschild JJ, Bangard C, et al. Our 2015 approach to invasive pulmonary aspergillosis. Mycoses 2015; 58:375-382.

Nucci M, Nouér SA, Cappone D, et al. Early Diagnosis Of Invasive Pulmonary Aspergillosis In Hematologic Patients: An Opportunity To Improve The Outcome. Haematologica 2013; 98:1657-1660.

Vehreschild JJ, Ruping MJ, Wisplinghoff H, et al. Clinical Effectiveness of Posaconazole Prophylaxis in Patients with Acute Myelogenous Leukaemia (AML): a 6 year Experience of the Cologne AML Cohort. J Antimicrob Chemother 2010; 65(7):1466-1471.

Cornely OA, Maertens J, Winston DJ, et al. Posaconazole vs. Fluconazole or Itraconazole Prophylaxis in Patients with Neutropenia. N Engl J Med 2007; 356(4):348–359.

Girmenia C, Frustaci AM, Gentile G, et al. Posaconazole Prophylaxis during front-line Chemotherapy of Acute Myeloid Leukemia: a single-center, real-life experience. Haematologica 2012; 97(4):560–567.

Sheppard DC, Campoli P, Duarte RF. Understanding Antifungal Prophylaxis with Posaconazole in Hematology Patients: an evolving bedside to bench story. Haematologica 2014; 99(4):603-604.


Copyright (c) 2015 Archive of Clinical Cases

Creative Commons License
Archive of Clinical Cases is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.


ISSN: 2360-6975