ABSTRACT
Acute myeloid leukemia was diagnosed in an infant with fever and pancytopenia. Intestinal obstruction was present at diagnosis and laparotomy performed after failure of conservative management demonstrated leukemic infiltration of the resected terminal ileum. Fever and intestinal obstruction persisted, necessitating a second ileal resection, which revealed invasive aspergillosis. Subsequent retrospective analysis identified occasional fungal hyphae in the initial resection specimen. With the combination of intensive chemotherapy and aggressive prolonged antifungal therapy the child survived. Invasive aspergillosis may unusually present at nonpulmonary sites at initial presentation of acute leukemia. Microbiological or histological diagnosis is needed to guide aggressive appropriate management.
Subject(s)
Aspergillosis/pathology , Ileal Diseases/microbiology , Intestinal Obstruction/etiology , Leukemia, Myeloid, Acute/complications , Antifungal Agents/therapeutic use , Antineoplastic Agents/therapeutic use , Humans , Ileal Diseases/drug therapy , Ileal Diseases/pathology , Ileal Neoplasms/drug therapy , Ileal Neoplasms/pathology , Infant , Intestinal Obstruction/surgery , Intestinal Obstruction/therapy , Leukemic Infiltration , Treatment OutcomeABSTRACT
Penetration of antimicrobial agents into the cerebrospinal fluid is dependent on numerous factors, including their serum protein binding, molecular size and lipid solubility, and degree of local inflammation. The choice of an appropriate agent is further complicated by diverse bacterial flora involved in brain abscess, local resistant patterns and activity of the drug in abscess environment. This update examines the conventional and newer agents in the above context for their role in the management of brain abscess.
