Hepatosplenic fungal infection in adult patients with acute leukemia.

Background: Hepatosplenic fungal infection is an important infectious complication in adult patients with acute leukemia. Methods: From 2001 to 2004, 163 adult patients were diagnosed with acute leukemia at our center: 41 patients had acute lymphoblastic leukemia (ALL) and 122 patients had acute myeloid leukemia (AML). Their charts were retrospectively reviewed. Results: Of these 163 patients, 16 patients (9.8%) developed hepatosplenic fungal infection: three were ALL patients and 13 were AML patients. All of these patients suffered from febrile neutropenia after chemotherapy. Duration of agranulocytosis (absolute neutrophil count < 500/dl) was 10 to 36 days, with a median of 20 days. Clinical presentations in these patients were fever (94%), diarrhea (50%), abdominal pain (44%), oral mucositis (44%), papular skin lesions (31%) and lower back pain (7%). Fourteen patients (88%) had elevated alkaline phosphatase levels between 197 U/l to 1172 U/l (normal range: 28-94 U/l). The most common infection sites found by computed tomography were the spleen (94%) and the liver (88%). All patients were treated with antifungal agents. No patient died as a result of the fungal infection episode. Nine patients (56%) died due to uncontrolled underlying hematological malignancies. The median duration of follow-up was 15.2 months (range: 2.3~47.4 months). Conclusion: Alkaline phosphatase level and computed tomography are useful tools for the diagnosis of hepatosplenic fungal infection. Infection-related mortality is very low with effective treatment. Treatment for underlying diseases should proceed as soon as possible if the infection has been controlled. (Chang Gung Med J 2008;31:74-80)