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

Abstract

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.