Invasive Aspergillosis of Posterior Nasal Cavity and Paranasal Sinuses Developed during the Induction Therapy for Acute Lymphoblastic Leukemia

A Report of a Girl Cured by Antifungal Agents and Surgical Debridement

Abstract

We report a 7-year-old girl with acute lymphoblastic leukemia who developed invasive aspergillosis of posterior nasal cavity and paranasal sinuses. During induction chemotherapy, fever that had once subsided as a result of antibiotics recurred with an elevation of CRP, and an ulcer (1 × 1 cm) of soft palate mucosa was noted. Based on the findings of computed tomography and a biopsy specimen from the soft palate, a diagnosis of invasive mycosis of the posterior nasal cavity and paranasal sinuses was done, and an intravenous administration of amphotericin B (AMPH-B) was started. However, the defect of the soft palate with necrotic tissues progressed, and the patient thus received extensive debridement of involved tissues and mucosa. The isolation of Aspergillus flavus from the soft palate and paranasal sinus was reported 7 days after the operation. A series of consolidation chemotherapy was safely performed by an administration of oral itraconazol and AMPH-B inhalation without a recurrence of aspergillosis. Not only is systemic treatment with antifungal agents required, but aggressive surgical debridement is also necessary for the cure of invasive Aspergillus sinusitis.