Development of Allergic Bronchopulmonary Aspergillosis-Like Symptom during Chemotherapy in a Girl with Acute Lymphoblastic Leukemia

• Published in: The Japanese Journal of Pediatric Hematology Vol. 17; no. 6; pp. 497 - 501
• Main Authors: YAMAKAWA, Naoko, TAN, Tetsushi, WATANABE, Miki, NAKAZAWA, Shinpei, TEZUKA, Toru, INUKAI, Takeshi, SUGITA, Kanji, UNO, Kanako, OKADA, Michiyo A., GOTO, Miwa
• Format: Journal Article
• Language: Japanese
• Published: THE JAPANESE SOCIETY OF PEDIATRIC HEMATOLOGY/ONCOLOGY 2003; 特定非営利活動法人 日本小児血液・がん学会
• Subjects: acute lymphoblastic leukemia; allergic bronchopulmonary aspergillosis; central bronchiectasis
• ISSN: 0913-8706; 1884-4723
• DOI: 10.11412/jjph1987.17.497

An 11-year-old girl with prolonged cough was diagnosed as having acute lymphoblastic leukemia. After induction therapy, she showed recurrent attacks of severe cough with marked sputum production. Following first consolidation therapy, she had high fever with an elevated serum CRP level. Chest X-ray films disclosed cavities with a fungus ball-like shadow over the left lung field, and a computed tomography scan of the chest showed the stenosis of left bronchus and the cystic lesions associated with consolidation and shadows like a fungus ball in S3 and S6 of left lung. Interactions of the cystic lesions to segmental bronchi were also noted, indicating the characteristics of central bronchiectasis. With a combined administration of anti-fungal agents, amphotericin B and itraconazole, fever and radiographic abnormalities such as consolidation and fungus ball-like appearance rapidly subsided, but the respiratory symptoms responded poorly to therapy until oral corticosteroids were administered. Since evidence for immunological hypersensitivity to aspergillus was not obtained, this case did not meet the criteria for allergic bronchopulmonary aspergillosis (ABPA). However, her clinical course, existence of central bronchiectasis, history of asthma in her mother, and HLA-DR2 serotype that is common in the patients with ABPA, suggest the contribution of allergic bronchopulmonary mycoses in this unusual respiratory complication.