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Successful treatment of Aspergillus spondylodiscitis with high-dose itraconazole in a patient with acute myelogenous leukemia

Leukemia volume 15, pages 1670–1671 (2001)Cite this article

A 51-year-old Japanese man with nasal bleeding was examined at our hospital for pancytopenia in July 1998. His peripheral WBC was 2.0 × 109/l with 37.0% neutrophils. The concentration of hemoglobin and the platelet count were 8.6 g/dl and 15 × 109/l, respectively. His bone marrow smear showed that the number of nucleated cells was 245 × 109/l and M/E ratio was 0.55. Myeloblasts occupied 31.6% of the non-erythroid nuclear cells in the smear. On the basis of these clinical data, he was diagnosed with acute myelogenous leukemia (M6), and induction chemotherapy was carried out with idarubicin (13 mg/m2, days 1–3) and Ara-C (100 mg/m2 by continuous i.v. infusion, day 1–7).

During the treatment, the patient exhibited febrile neutropenia. All cultures from his blood, throat, urine and stool were negative. However, his serum β-D-glucan level was elevated at 188.0 pg/ml (normal <20 pg/ml). 67Ga scintillation scan did not reveal any focus of inflammation and no Pneumocystis carinii DNA was detected using polymerase chain reaction (PCR). Therefore, a fungal pathogen was highly suspected, and amphotericin B (AMPH) was initiated at 50 mg/day. The dose of AMPH was gradually increased to 150 mg/day due to the lack of response, and although 150 mg/day of AMPH was administered for 25 days, his high fever continued and the serum value of β-D-glucan remained elevated (100–120 pg/ml). The total dose of administered AMPH reached to 6600 mg. Since an uncontrolled mycotic infection was suspected, a high dose of itraconazole (ITCZ) per os, initially 500 mg/day followed by 700 mg/day, was administered and serum level of β-D-glucan decreased (25–45 pg/ml). The patient's high fever was lowered. It was considered that high dose of ITCZ was effective in this patient.

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Authors and Affiliations

  1. First Department of Internal Medicine, Fukui Medical University, Japan

    K Takagi, A Yoshida, T Yamauchi, T Yamashita, H Tsutani & T Ueda

  2. Division of Transfusion Medicine, Department of Orthopaedic Surgery, Fukui Medical University, Japan

    H Iwasaki, Y Maezawa & H Baba

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  1. K Takagi
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Takagi, K., Yoshida, A., Yamauchi, T. et al. Successful treatment of Aspergillus spondylodiscitis with high-dose itraconazole in a patient with acute myelogenous leukemia. Leukemia 15, 1670–1671 (2001). https://doi.org/10.1038/sj.leu.2402209

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