Abstract
A 19-year-old man with acute lymphocytic leukemia (ALL) FAB classification ALL L2, was admitted to our hospital for induction chemotherapy in September 1992. The patient achieved complete remission after one course of chemotherapy according to the Japan Adult Leukemia Study Group (JAL-SG) protocol. In August 1994, bone marrow biopsy demonstrated a relapse.
The patient was treated with prednisolone and vincristine, followed by therapy with cytosine-arabinoside and L-asparaginase a few weeks later.
Myelosuppression led to a long period of neutropenia, and a high grade fever appeared. He developed erythematous nodules on the penis and right leg. One of these nodules ( about 1cm in diameter) was very inflamed and painful and had a dark black necrotic center. Similar lesions became prominent on the trunk, extremities, and scalp. The biopsy finding of the skin lesion showed separate hyphae and yielded Fusarium solani.
Human recombinant granulocyte colony stimulating factor of 350μg/day was begun.
Amphotericin B was begun at a dose of 1mg/day and increased to 40mg/day. The patient remained severely neutropenic, and new skin lesions appeared. Despite this treatment, he died of septic shock. Culture of the intravenous line catheter showed Pseudomonas aeruginosa. At autopsy, nodules were disseminated through multiple organs, especially the lungs, gastrointestinal tract, kidney, heart, pancreas and muscles. The nodules were about 1cm in diameter with a black necrotic center and partial thrombosis. Histologically, they were areas of deep-seated mycosis due to Fusarium solani.
