INVASIVE ORAL ASPERGILLOSIS IN IMMUNOCOMPROMISED PATIENTS WITH LEUKEMIA

The clinicopathologic characteristics of invasive oral aspergillosis i n 16 immunocompromised patients who developed this infection during an tileukemic chemotherapy are described. The primary site of the infecti on was the marginal gingiva, there was severe spontaneous pain, and th e patients developed spiking fever and granulocytopenia. Necrotic ulce ration of the gingiva rapidly extended to the contiguous mucosa, muscl e, and bone. Microscopically, the necrotic tissue contained thrombotic vascular infarcts and there were hyphae that showed frequent transver se septa and dichotomous branching. The invasive organisms were not re sponsive to amphotericin B in the absence of remission of the leukemia and restoration of the depressed host defenses. In 15 patients who sh owed improvement of hematologic status, oral aspergillosis was control led by the combination of antifungal chemotherapy and debridement of n ecrotic tissues.