Fatal haemoptysis induced by invasive pulmonary aspergillosis in patients with acute leukaemia during bone marrow and clinical remission: Report of two cases and review of the literature

We describe two patients with acute leukaemia who died of massive haemoptys is caused by invasive pulmonary aspergillosis (IPA), The fatal event occurr ed during the period of bone marrow remission which followed chemotherapy-i nduced neutropenia. This is a rare complication. We were able to find addit ional 17 similar cases in the English literature, which we review Clinically, the picture consisted of unremitting fever with profound and pr olonged neutropenia, cough and dyspnoea, Both our patients were treated wit h broad-spectrum antibiotics, fluconazole and amphotericin B, An upper lobe infiltrate in one case, and a progressive pleural effusion in the other, w ere late findings on chest radiographs during the period of bone marrow rec overy. Both patients succumbed to sudden massive haemoptysis during the per iod of bone marrow and clinical improvement. In conclusion, patients with acute non-lymphoid leukaemia are at significan t risk for IPA-induced fatal haemoptysis during bone marrow and clinical re mission. A high index of suspicion should be sustained throughout the entir e clinical course, In view of the potential fatal outcome, aggressive diagn ostic and treatment efforts are mandatory (C) 2000 The British Infection So ciety.