Ruptured Klebsiella pneumoniae liver abscess after high-dose cyclophosphamide for severe aplastic anemia

A 19-year-old woman with severe aplastic anemia who had previously failed a ntithymocyte globulin/cyclosporine A received high-dose cyclophosphamide wi thout bone marrow rescue. On day +14, she complained of right upper quadran t abdominal pain and fever. A CT scan of the abdomen showed multiple liver abscesses with rupture and Klebsiella pneumoniae was isolated from blood, I n spite of aggressive antibiotic therapy, she rapidly deteriorated and died of overwhelming sepsis, To our knowledge, our patient is the first case of fatal ruptured liver abscess after high-dose cyclophosphamide in a patient with severe aplastic anemia. (C) 4000 Wiley-Liss. Inc.