Hepatosplenic Microabscesses in Pediatric Leukemia: A Report of Five Cases

小兒急性白血病併發瀰散性微小肝脾膿瘍 ─ 五病例經驗

林佩瑾(Pei-Chin Lin) ； 張泰琮(Tai-Tsung Chang) ； 章人欽(Ren-Chin Jang) ； 邱世欣(Shyh-Shyn Chiou)

《The Kaohsiung Journal of Medical Sciences》 19卷7期 (2003/07) Pp. 368-374

摘要

瀰散性微小肝脾膿瘍是一種不常見的疾病，通常發生在先天免疫缺陷或癌症的患者。診斷及治療都相當困難而且可能會危及性命，尤其是生在癌症患者，因為化學治療可能導致肝脾膿瘍惡化，更加重了處理上的困難。本文收集了5位4-18歲急性淋巴性白血病併發瀰散性微小肝脾膿瘍的案例。這些患者皆於引導療程後出現長時間的白血球低下以及發燒，接著分別有腹痛、肝脾腫大或肝功能異常的情形。影像學檢查包括超音波、電腦斷層及核磁共振攝影，顯示有肝脾念珠菌感染造成的瀰散性微小膿瘍。5位患者中有2位於血液培養或糞便培養中發現念珠菌。經過抗徽菌藥物治療，有2位存時間)event-free survival)超過24個月，經由持續追蹤影像學檢查發現膿瘍明顯減少。抗徽菌藥物使用的時間3-22個月。在處理這些病例上，主要面臨的問題包括：使用抗徽菌藥物的時間長短、如何選擇抗徽茵藥物和決定適當劑量以防止腎臟毒性的發生。

關鍵字

瀰散性微小肝脾膿瘍 ； 白血病

並列摘要

Hepatosplenic microabscesses secondary to invasion by various organisms may result in life-threatening conditions, especially in patients with cancer. Whether these patients should continue ongoing cytotoxic therapy, which might result in neutropenia, with the risk of progressive abscess formation or fungemia, remains a dilemma. We report five cases of pediatric acute leukemia with hepatosplenic microabscesses in children aged 4 years to 18 years. These patients presented with prolonged fever and neutropenia after antineoplastic chemotherapy, followed by abdominal pain, hepatosplenomegaly and hepatic dysfunction. Abdominal ultrasound and computed tomography (CT) or magnetic resonance imaging (MRI) demonstrated multiple small lesions compatible with hepatosplenic candidiasis in all of the patients. Cultures, including blood or stool cultures, were positive in only two cases. Treatment with intravenous antifungal agents, including amphotericin B, liposomal amphotericin B, and / or fluconazole were successful in two cases. These two patients remained event-free and survived for more than 24 months (20 months and 22 months after infection was diagnosed). The duration of systemic antifungal medication administration ranged from 3 months to 22 months. The serial image examinations revealed drastic reductions in small residual lesions in the two patients who survived the longest. The major issues for these patients were how long the antifungal therapy should be administered for, and how to select the optimal drug and dosage to avoid hepatic and renal toxicity. Among our patients, alternative therapy with amphotericin B, liposomal amphotericin B, and fluconazole was used according to the patients' conditions, and the duration of antifungal therapy Was determined by clinical manifestations and imaging study changes.

並列關鍵字

hepatosplenic microabscess ； leukemia ； liposomal amphotericin B