急性リンパ性白血病に対する化学療法中にＡｌｌｅｒｇｉｃ　Ｂｒｏｎｃｈｏｐｕｌｍｏｎａｒｙ　Ａｓｐｅｒｇｉｌｌｏｓｉｓ　様の病像を呈した小児例

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

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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.

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