E.K. ÖZTURK, N SOYER, M. TÖBÜ, S. BAYRAKTAROĞLU, M. HEKİMGİL, B. ARDA

Successful treatment of chronic disseminated candidiasis in acute myeloid leukemia patient

Kronik dissemine kandidiyazis (KDK) sistemik yaygın bir kandida enfeksiyonu çeşididir ve nötropenik hastaları etkiler. Bu vaka sunumunda remisyon indüksiyon kemoterapisi sırasında KDK tanısı alan ve sırasıyla amfoterisin B ve flukonazol ile tedavi edilen bir akut myeloid lösemi olgusu sunulmuştur. Kemoterapi sonrası geniş spektrumlu antibiyotiklere yanıtsız ateş ortaya çıktı. Lipozomal amfoterisin B (Lip-Amf-B) tedavisi başlandı. Serum galaktomannan (GM) testi ve kan kültürleri negatifti. Yüksek rezolüsyonlu bilgisayarlı tomografi (BT) normaldi. Hasta nötropeniden çıkınca ve ateşi kontrol edilince Lip-Amf-B tedavisi kesildi. Tüm tedavisi kesildikten sonra hastanın tekrar ateşi yükseldi ve karın ağrısı ortaya çıktı. Serum alkalen fosfataz seviyesi yükseldi. Kan kültürleri ve serum GM testi negatif olan hastada abdominal BTde dalakta multipl nodüler lezyonlar görüldü. KDK tanısı düşünüldü. Hastamız amfoterisin B ile başarılı bir şekilde tedavi edildi. Geniş spektrumlu antibiyotiklere yanıt vermeyen ateşi olan, kemoterapi yapılmış akut myeloid lösemi olgularında KDK akla getirilmelidir.

Akut myeloid lösemi hastasında kronik dissemine kandidiyazisin başarılı tedavisi

Chronic disseminated candidiasis (CDC) is a type of systemic disseminated candida infection and affects neutropenic patients. In this case report, a patient with acute myeloid leukemia (AML) who was diagnosed with CDC during remission induction chemotherapy and treated with amphotericin B and fluconazole respectively is reported. After chemotherapy, a fever that was unresponsive to broad spectrum antibiotic treatment occurred in the patientLiposomal amphotericin B (lip-amp-B) treatment was started. Serum galactomannan (GM) screening and blood cultures were negative. High resolution computed tomography (CT) was normal. Lip-amp-B treatment was stopped after an afebrile, non-neutropenic period was documented. After all treatment was stopped, the patient became febrile again and abdominal pain occurred. The serum alkaline phosphatase (ALP) level was increased. Blood cultures and GM teswere negative and an abdominal CT showed multiple nodular lesions in the spleen. CDC was considered. The patienwas treated successfully with amphotericin B. This should be kept in mind in cases of CDC in AML patients who were treated with chemotherapy especially if the fever cannot be controlled although broad spectrum antibiotics.

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