Case Report
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World J Hematol. May 6, 2014; 3(2): 44-48
Published online May 6, 2014. doi: 10.5315/wjh.v3.i2.44
Chronic disseminated candidiasis complicated with a ruptured intracranial fungal aneurysm in ALL
Teppei Okawa, Toshiaki Ono, Akifumi Endo, Masatoshi Takagi, Masayuki Nagasawa
Teppei Okawa, Toshiaki Ono, Akifumi Endo, Masatoshi Takagi, Masayuki Nagasawa, Department of Developmental Biology, Post Graduate School, Tokyo Medical and Dental University, Tokyo 113-8519, Japan
Teppei Okawa, Masayuki Nagasawa, Department of Hematology Oncology and Immunology, Tokyo Bay Urayasu/Ichikawa Medical Center, Chiba 279-0001, Japan
Author contributions: Okawa T and Nagasawa M designed the report; Okawa T, Ono T, Endo A and Takagi M collected the patient’s clinical data; Okawa T, and Nagasawa M analyzed the data and wrote the paper.
Supported by The Grant-in-Aid for Scientific Research from Ministry of Education, Science and Culture Japan, No. 24591541 to Masayuki Nagasawa
Correspondence to: Masayuki Nagasawa, MD, PhD, Department of Developmental Biology, Post Graduate School, Tokyo Medical and Dental University, 5-45, Yushima 1-chome, Bunkyo-ku, Tokyo 113-8519, Japan. mnagasawa.ped@tmd.ac.jp
Telephone: +81-3-58035250 Fax: +81-3-58035247
Received: September 30, 2013
Revised: December 23, 2013
Accepted: January 17, 2014
Published online: May 6, 2014
Abstract

An 11-year-old boy with acute lymphocytic leukemia (ALL) contracted disseminated candidiasis during induction therapy, which was complicated with rupture of a fungal cranial aneurysm. Ventricular drainage and coil embolization of a residual aneurysm in combination with intensive antifungal therapy rescued the patient. Although clinical improvement was achieved, high fever and elevated levels of C-reactive protein and β-D-glucan continued for more than 10 mo. One year later, the ALL relapsed during maintenance therapy with methotrexate and 6-mercaptopurine. After salvage chemotherapy, the patient received unrelated bone marrow transplantation (BMT) in a non-complete remission condition and survived. During subsequent chemotherapy and BMT, no recurrence of the fungal infection was observed under the prophylactic anti-fungal therapy with micafungin.

Keywords: Disseminated candidiasis, β-D-glucan, Fungal cranial aneurysm, Acute lymphocytic leukemia, Bone marrow transplantation

Core tip: Chronic disseminated candidiasis and resulting fungal intracranial aneurysm is a life-threatening complication during the induction therapy of leukemia with a poor survival rate. However, intensive and patient anti-fungal treatment made the patient receive unrelated bone marrow transplantation successfully.