FATAL PULMONARY HEMORRHAGE IN PATIENTS WITH ACUTE-LEUKEMIA AND FULMINANT PNEUMONIA CAUSED BY STENOTROPHOMONAS-MALTOPHILIA

Pulmonary hemorrhage is a rare cause of death in patients with acute l eukemia. Within a 3-month period we observed three such cases, all of which were associated with the gram-negative opportunistic pathogen St enotrophomonas maltophilia. Since fatal lung bleeding had previously n ot been observed in conjunction with this organism, we collected the d ata from all patients with documented S. maltophilia infections or col onizations of the past year and analyzed the risk factors for a lethal outcome. A total of eight patients were identified. In the three pati ents with fatal hemorrhage, the interval between first complaints (che st pain, cough, fever) and death from lung bleeding was 36-72 h. A fou rth patient with acute leukemia died of nonhemorrhagic respiratory fai lure 9 days after developing S. maltophilia-associated pneumonia. All four patients had received intensive chemotherapy and were severely ne utropenic and thrombocytopenic. Such a combination of predisposing fac tors was not observed in the four patients with nonfatal infections or colonizations. Pulsed-field gel electrophoresis demonstrated that the infections were unrelated. S. maltophilia was also isolated from a fa ucet in a patient's room, but the strain isolated was genetically diff erent from the strain causing the patient's pneumonia. Our data sugges t that severe bone marrow aplasia and a recent history of intensive ch emotherapy are predisposing factors for the development of fulminant h emorrhagic S. maltophilia pneumonia. Since some of the infections and colonizations developed despite prophylactic administration of antibac terial agents with documented in vitro activity against the pathogen a nd none was controlled by such agents, it is clear an efficient treatm ent strategy needs to be developed.