Aspergillus osteoarthritis in acute lymphoblastic leukemia

We report an unusual case of arthritis of the right wrist due to Aspergillu s fumigatus without evidence for a generalized infection, following chemoth erapy for acute lymphoblastic leukemia. The diagnosis was made by surgical biopsy. Amphotericin-B (Am-B) was not tolerated by the patient. Liposomal p reparations of Am-B penetrate poorly into bone and cartilage. Therefore, or al itraconazole was given; the arthritis improved and chemotherapy was cont inued without infectious complications. Two weeks after complete hematopoie tic recovery, an intracranial hemorrhage from a mycotic aneurysm of a brain vessel occurred, although the patient was still receiving itraconazole. We emphasize the importance of prompt and thorough efforts to identify the ca usative agent in immunocompromised patients with a joint infection. Itracon azole is effective in Aspergillus osteoarthritis but, due to its poor penet ration into the brain, the combination with a liposomal formulation of Am-B is recommended.