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Song, Lee, Seo, Kim, Bin, Woo, Jun, Cho, Son, and Lee: A Case of Fatal Multiple Cerebral Aspergillosis in a Patient with Acute Promyelocytic Leukemia during Complete Remission
Case Report

Korean J Hematol 2005;40(3):167-171.

Published online: 21 September 2005

DOI: https://doi.org/10.5045/kjh.2005.40.3.167

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

Myoung Joon Song, M.D.1, Dong-Gun Lee, M.D.1, Suk Min Seo, M.D.2, Won Chul Kim, M.D.2, Hong Gern Bin, M.D.2, Hyun Young Woo, M.D.2, Yeon Joo Jun, M.D.2, Seok Goo Cho, M.D.2, Byung Cheol Son, M.D.3, Hae Kyung Lee, M.D.4

1Division of 1Infection, College of Medicine, The Catholic University of Korea, Seoul, Korea

2Hematology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea

3Department of Neurosurgery, College of Medicine, The Catholic University of Korea, Seoul, Korea

4Department of Clinical Pathology, College of Medicine, The Catholic University of Korea, Seoul, Korea

Correspondence to: Seok Goo Cho, M.D. Division of Hematology, Department of Internal Medicine, Catholic Hematopoietic Stem Cell Transplantation Center, St. Mary's Hospital, College of Medicine, The Catholic University of Korea 62, Youido-dong, Yeongdeungpo-gu, Seoul 150-713, Korea Tel: +82-2-3779-1130, Fax: +82-2-780-3132 E-mail: chosg@catholic.ac.kr

Received 27 July 2005       Revised 12 September 2005       Accepted 12 September 2005

Copyright © 2005 Korean Society of Hematology

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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 hemisphereswere 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.

Keywords: Aspergillosis, Brain infarction, Acute promyelocytic leukemia, Complete remission

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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.
kjh-40-167f1.tif
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.
kjh-40-167f2.tif
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