FIRST CASE OF DISSEMINATED MYCOBACTERIUM-AVIUM INFECTION FOLLOWING CHEMOTHERAPY FOR CHILDHOOD ACUTE MYELOID-LEUKEMIA

A 14-year-old girl of Indian origin with acute myeloid leukemia (AML) is presented, who was diagnosed at the age of twelve, Antileukemic che motherapy had to be discontinued after 6 weeks because of persistent h igh fever and the emergence of liver and spleen abscesses, Serologic a nd biopsy findings were consistent with disseminated candidiasis; howe ver, a liver biopsy also revealed granulomatous lesions with caseous d egeneration. No acid-fast bacilli could be detected, Upon antifungal t reatment the patient's condition improved, but fever spells and high i nflammatory blood parameters persisted. One year after the diagnosis o f AML was established, Mycobacterium avium was cultured from bone marr ow aspirates. The patient's cellular immunity was severely compromised at that time as reflected by the marked depression of T-lymphocyte co unts, in particular of CD4-positive cells. HIV and other lymphotropic virus infections were subsequently excluded, After 5 months of specifi c treatment the patient recovered from mycobacterial infection and rem ains in first remission of AML. Opportunistic infections have rarely b een diagnosed in oncologic patients to date, while data on T-cell func tion in AML is sparse, Fever of unknown origin should prompt the searc h for infectious agents unusual to date in this patient group.