Contributions
Abstract: PB1649
Type: Publication Only
Background
Aspergillus flavus is a rare but increasingly common mold fungus. Especially in hematologic malignancies, it is seen as a factor in the neutropenic period when the immunity system is suppressed; and mortality is high in these patients.
Aims
We aimed to present a case of by Aspergillus flavus osteomyelitis with in an adolescent with acute lymphoblastic leukemia (ALL).
Methods
A 14-year-old male patient with ALL was hospitalized with neutropenia on the 30th day of treatment. On the 12th day of neutropenia, treatment with amikacin, meropenem and liposomal amphotericin B was initiated. In this period, the patient developed swelling of the left knee joint. Magnetic resonance imaging (MRI) showed that may be compatible with abscess and osteomyelitis in left femur distal metaphyseal. The patient was operated and intraarticulary washing was performed, the soft tissue / bone curettage materials were sent to pathology and microbiology laboratories.Pathology was again reported as fungal osteomyelitis. Aspergillus flavus was grew from the tissue samplesThe minimum inhibitor concentration (MIC) values for amphotericin B, caspofungin, voriconazole, anidulafungin, itraconazole and posaconazole were > 2 μg / ml, 0.125 μg / ml, 0.064 μg / ml, 0.002 μg / ml, 0.25 μg / ml, and 0.125 μg / ml. Amphotericin B in the patient was discontinued and voriconazole was started because the A. flavus strain was resistant to amphothericin B. Progression was seen in the patient's knee MRI with complaints after the second week of voriconazole treatment. For the third time, the patient was treated with curettage and washing with voriconazole. Aspergillus-compatible fungi were seen in specimens taken prior to washing with voriconazole and sent to the mycology laboratory. Although galactomannan antigenemia tests in blood samples were negative during neutropenia, galactomannan antigenemia test was positive in the last joint fluid and tissue sample. However, there was no reproduction in culture. Caspofungin was added to the patient's treatment.
Results
Fungal infections and especially osteomyelitis related to Aspergillus species should be considered in children with ALL and neutropenia.
Conclusion
It should be kept in mind that A.flavus, which is seen more rarely, may also be resistant to the agent and amphotericin B as a Nosocomial fungal infecion
Session topic: 2. Acute lymphoblastic leukemia - Clinical
Keyword(s): Acute lymphoblastic leukemia
Abstract: PB1649
Type: Publication Only
Background
Aspergillus flavus is a rare but increasingly common mold fungus. Especially in hematologic malignancies, it is seen as a factor in the neutropenic period when the immunity system is suppressed; and mortality is high in these patients.
Aims
We aimed to present a case of by Aspergillus flavus osteomyelitis with in an adolescent with acute lymphoblastic leukemia (ALL).
Methods
A 14-year-old male patient with ALL was hospitalized with neutropenia on the 30th day of treatment. On the 12th day of neutropenia, treatment with amikacin, meropenem and liposomal amphotericin B was initiated. In this period, the patient developed swelling of the left knee joint. Magnetic resonance imaging (MRI) showed that may be compatible with abscess and osteomyelitis in left femur distal metaphyseal. The patient was operated and intraarticulary washing was performed, the soft tissue / bone curettage materials were sent to pathology and microbiology laboratories.Pathology was again reported as fungal osteomyelitis. Aspergillus flavus was grew from the tissue samplesThe minimum inhibitor concentration (MIC) values for amphotericin B, caspofungin, voriconazole, anidulafungin, itraconazole and posaconazole were > 2 μg / ml, 0.125 μg / ml, 0.064 μg / ml, 0.002 μg / ml, 0.25 μg / ml, and 0.125 μg / ml. Amphotericin B in the patient was discontinued and voriconazole was started because the A. flavus strain was resistant to amphothericin B. Progression was seen in the patient's knee MRI with complaints after the second week of voriconazole treatment. For the third time, the patient was treated with curettage and washing with voriconazole. Aspergillus-compatible fungi were seen in specimens taken prior to washing with voriconazole and sent to the mycology laboratory. Although galactomannan antigenemia tests in blood samples were negative during neutropenia, galactomannan antigenemia test was positive in the last joint fluid and tissue sample. However, there was no reproduction in culture. Caspofungin was added to the patient's treatment.
Results
Fungal infections and especially osteomyelitis related to Aspergillus species should be considered in children with ALL and neutropenia.
Conclusion
It should be kept in mind that A.flavus, which is seen more rarely, may also be resistant to the agent and amphotericin B as a Nosocomial fungal infecion
Session topic: 2. Acute lymphoblastic leukemia - Clinical
Keyword(s): Acute lymphoblastic leukemia