Successful treatment of invasive mould infection affecting lung and brain in an adult suffering from acute leukaemia

We describe in detail a 67-yr-old woman who was treated with a-cytostatic c ombination chemotherapy for newly diagnosed common-acute lymphoblastic leuk aemia. At the end of induction therapy. the patient acquired invasive mould infection affecting lung and brain. The patient entered complete remission of her leukaemia. Treatment with liposomal amphotericin B was initiated al ong with surgical excision of the fungal brain abscess. Intrathecal instill ation of amphotericin B deoxycholate was started using an Ommaya reservoir because of an anatomical connection between the postoperative cavity and th e ventricle. Full dose cytostatic chemotherapy was continued with little de lay. A computerised tomography scan of the chest performed 2 months later r evealed no fungal abscesses. Magnetic resonance imaging of the brain did no t reveal any fungal manifestation. During maintenance therapy/week 69, the patient relapsed from leukaemia. High doses of intravenous liposomal amphot ericin B were administered prophylactically. The patient's leukaemia proved refractory to reinduction chemotherapy and the patient died from pneumonia 8 wk later. Post mortem microbiological investigation and histopathologica l examination of lung and brain tissue did not reveal any macroscopical or microscopical fungal manifestations. This case underlines the feasibility a nd successful application of combined antileukaemic, antifungal and surgica l therapy in a patient with acute leukaemia.