Aspergillus osteoarthritis in acute lymphoblastic leukemia |
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Authors: | E Gunsilius C Lass-Flörl E Mur C Gabl G Gastl A L Petzer |
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Institution: | (1) Division of Hematology and Oncology, University Hospital, Anichstrasse 35, A-6020 Innsbruck, Austria e-mail: eberhard.gunsilius@uibk.ac.at Tel.: 0043-512-5048668, fax: 0043-512-5048670, AT;(2) Department of Microbiology, University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria, AT;(3) Department of Internal Medicine, University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria, AT;(4) Department of Pathology, University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria, AT |
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Abstract: | We report an unusual case of arthritis of the right wrist due to Aspergillus fumigatus without evidence for a generalized infection, following chemotherapy for acute lymphoblastic leukemia. The diagnosis was
made by surgical biopsy. Amphotericin-B (Am-B) was not tolerated by the patient. Liposomal preparations of Am-B penetrate
poorly into bone and cartilage. Therefore, oral itraconazole was given; the arthritis improved and chemotherapy was continued
without infectious complications. Two weeks after complete hematopoietic recovery, an intracranial hemorrhage from a mycotic
aneurysm of a brain vessel occurred, although the patient was still receiving itraconazole. We emphasize the importance of
prompt and thorough efforts to identify the causative agent in immunocompromised patients with a joint infection. Itraconazole
is effective in Aspergillus osteoarthritis but, due to its poor penetration into the brain, the combination with a liposomal formulation of Am-B is recommended.
Received: January 4, 1999 / Accepted: June 21, 1999 |
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Keywords: | Aspergillus fumigatus Osteoarthritis Itraconazole Leukemia |
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