FATAL HEMOPTYSIS IN PULMONARY FILAMENTOUS MYCOSIS - AN UNDEREVALUATEDCAUSE OF DEATH IN PATIENTS WITH ACUTE-LEUKEMIA IN HEMATOLOGICAL COMPLETE REMISSION - A RETROSPECTIVE STUDY AND REVIEW OF THE LITERATURE

A retrospective study on a consecutive series of 116 patients affected by acute leukaemia with documented pulmonary filamentous mycosis (FM) admitted between 1987 and 1992 to 14 tertiary-care hospitals in Italy was made in order to evaluate the characteristics of those patients w ho developed fatal massive haemoptysis. In 59/116 cases of pulmonary F M the infection was the principal cause of death and in 12 of these pa tients a massive haemoptysis was responsible for death, The diagnosis of FM infection was made ante-mortem in only four out of these 12 pati ents. The autopsy was performed in 11/12 patients and documented a FM infection, The mycetes isolated were: Hyphomycetes spp, (three patient s), Mucorales spp, (two patients), Aspergillus spp, (seven patients). At the time of the massive haemoptysis the mean neutrophil count was 7 .2x10(9)/l, and no patient had relevant thrombocytopenia (mean 184x10( 9)/l, range 28-350) or coagulative abnormalities, The mean time which elapsed between resolution of chemotherapy-induced neutropenia (WBC <1 0(9)/l) and occurrence of haemoptysis was 7 d. No signs or symptoms pr edictive of this fatal complication were identified. Massive haemoptys is can be the cause of death in patients with acute leukaemia and pulm onary FM which in the majority of patients was not diagnosed in vivo, This complication occurs most frequently shortly after the recovery fr om chemotherapy-induced aplasia, The mechanism of lesion is unknown, b ut it may involve the vascular tropism of FM and the release of leucoc yte enzymes, Better preventive and therapeutic antifungal treatments a re needed to avoid this serious, albeit rare, complication.