Korean J Hematol.  2005 Sep;40(3):167-171. 10.5045/kjh.2005.40.3.167.

A Case of Fatal Multiple Cerebral Aspergillosis in a Patient with Acute Promyelocytic Leukemia during Complete Remission

• Song MJ
• Lee DG
• Seo SM
• Kim WC
• Bin HG
• Woo HY
• Jun YJ
• Cho SG
• Son BC
• Lee HK

• KMID: 1610810
• DOI: http://doi.org/10.5045/kjh.2005.40.3.167

Abstract

Cerebral aspergillosis accounts for about 10% of all the cases of invasive aspergillosis. The brain is the only infected site in less than 10% of cases. The patients at high risk for of aspergillosis are immunocompromised patients such as those in a neutropenic state after chemotherapy, AIDS and etc. We experienced a case of cerebral aspergillosis in a patient with acute leukemia that was in complete remission. The patient visited our hospital's ER due to nasal bleeding, and then he was quickly diagnosed as having acute promyelocytic leukemia. After the first induction chemotherapy, he achieved a complete remission. Loss of consciousness developed on day 31 after chemotherapy. High signal intensity in the right temporooccipital lobe and multiple nodular lesions in both cerebral hemispheres were observed on the brain MRI. Stereotaxic biopsy showed septate aspergillus hyphae in the brain specimen. Despite of the use of amphotericin B deoxycholate, the patient died of recurrent grand mal seizure and multiple organ failure.

Keyword

Aspergillosis; Brain infarction; Acute promyelocytic leukemia; Complete remission

MeSH Terms

Amphotericin B
Aspergillosis*
Aspergillus
Biopsy
Brain
Brain Infarction
Cerebrum
Deoxycholic Acid
Drug Therapy
Epistaxis
Humans
Hyphae
Immunocompromised Host
Induction Chemotherapy
Leukemia
Leukemia, Promyelocytic, Acute*
Magnetic Resonance Imaging
Multiple Organ Failure
Seizures
Unconsciousness
Amphotericin B
Deoxycholic Acid

Figure

• 

  Fig. 1. (A) Axial T2-weighted image shows confluent high signal intensity in the right temporal and occipital regions. Multiple nodular high signal intensity lesions are scattered in both cerebral hemispheres. (B) Axial T1-weighted image shows hyposignal intensity in the corresponding areas of T2 abnormality. Thin high signal along the surface of the right temporo-occpital region may indicate hemorrhage. (C) Axial T1-weighted image with Gadolinium enhancement demonstrates diffuse gyral enhancement of the right temporal and occipital lobes and multiple ring enhancing nodules in both cerebral hemispheres. C onsistent with subacute infarction and multiple brain abscesses.

• 

  Fig. 2. (A) Stereotaxic biopsy specimen shows white-to-greenish surfaced granuloma with 1cm diameter. (B) PAS-stained section of the cerebral abscess biopsy specimen showing septate Aspergillus hyphae (arrow), × 400.

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