Fulminant pulmonary Aspergillus infection occluding the aortic arch after high-dose antileukemic chemotherapy

Article Abstract:

Various parts of the immune system differ with regard to the foreign organisms that they combat best. Potentially infectious fungi are destroyed by white blood cells called granulocytes, and thus it is not surprising that fungal infections can be a complication of prolonged granulocytopenia, a condition in which the number of circulating granulocytes is reduced. Granulocytopenia can be a complication of the chemotherapy used to treat leukemia, reducing the ability of the immune system to fight infection. Often, in this immunocompromized state, the patient falls victim to infection of the lungs by the fungus Aspergillus. Pulmonary aspergillus infection is often hard to recognize, since the initial symptoms are similar to those of any common respiratory infection. However, unlike most common respiratory infections, Aspergillus infection can be rapidly progressive and fatal. In a recent case, Aspergillus infection resulted in death in a rather unusual fashion; the fungus invaded a major blood vessel and caused a giant blood clot. The patient was a 20-year-old man undergoing chemotherapy for myelodysplastic syndrome. One week after the end of chemotherapy the patient complained of chest pain and had a slight fever. He could not produce any sputum for analysis, but it was assumed that he had developed an infection and was given antibiotics. After one week, the entire lung seemed to be involved in the infection. A biopsy was considered, but rejected due to the general ill health of the patient. The following day he was found dead just prior to his scheduled transfer to the intensive care unit. At autopsy, fungi of an Aspergillus species were found in his blood vessels and a major blood clot was found blocking the aortic arch (the major artery which leaves the heart and serves the back and lower body). This case illustrates how rapidly Aspergillus can cause death. Furthermore, it provides an example of how many diagnostic procedures can fail to identify an Aspergillus infection during life. In one reported series of 91 patients, Aspergillus infection could be identified during life in only 32. Tissue obtained at autopsy, from patients who are known to be infected and when any tissue can be freely cultured, commonly yields false negative results (incorrectly indicates the absence of Aspergillus infection). The culture of autopsy tissues may provide false negative results in as many as 30 percent of all Aspergillus infections. (Consumer Summary produced by Reliance Medical Information, Inc.)

Infection, Complications and side effects, Aspergillus, Chemotherapy, Granulocytopenia, Aorta, Thoracic, Thoracic aorta

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Chemotherapy and radiation therapy for anal carcinoma: survival and late morbidity

Article Abstract:

Traditionally, surgery was the standard treatment for cancer of the anal canal. However, anal cancer aggressively infiltrates adjacent tissues, so that in many cases, even when the surgical resection of the cancer appeared to be complete, the cancer recurred locally and the patient died. The combination of radiotherapy and chemotherapy has now achieved preeminence in the treatment of anal cancer. Since anal cancer is relatively uncommon, however, the published reports of treatment effectiveness have generally included few patients. In addition, these studies have not employed a uniform and clearly defined system for the staging of the disease prior to treatment. To evaluate the survival and recurrence of anal cancer, a study was conducted of 106 patients receiving 5,000 cGy of radiation treatment in addition to chemotherapy with mitomycin C and 5-fluorouracil (a Gy, or Gray, is the radiation equivalent of one joule of energy absorbed per kilogram of body tissue.) Of the 106 patients, 86 received treatment for primary tumors. These patients had a complete response rate of 84 percent and a five-year survival rate of 72 percent; the survival rate was not found to be dependent upon the stage of the disease. Twenty patients were being treated not for primary cancer, but for anal cancer which had recurred after surgery. Among these patients, the complete response rate was only 50 percent, and only 40 percent were alive after five years. Treatment-related symptoms such as anal incontinence, intestinal obstruction, or chronic pelvic pain were experienced by 15 percent of the patients. Therefore, the current treatment is effective, but at the cost of a high rate of complications. The observation that the stage of the disease did not affect patient survival in this study suggests that the local control of the primary tumor is of paramount importance in the control of anal cancer. It may therefore be appropriate to adjust the dose of radiation therapy to the size of the primary cancer, and to limit the higher doses of radiation to only those cases with more advanced local anal cancer. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Anal cancer

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