Case report
Aspergillus laryngotracheobronchial infection in a 6-year-old girl following bone marrow transplantation

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Abstract

Localised fungal infection of the larynx and tracheobronchial tree is extremely uncommon. We report the case of a 6-year-old girl with acute lymphocytic leukaemia, who developed symptoms of upper airways obstruction 6 months after a cord blood transplant. Bronchoscopy showed a pale plaque lesion in the larynx and tracheobronchial tree. Aspergillus fumigatus was cultured from a biopsy of the lesion. The patient was treated successfully with a prolonged course of amphotericin B and assessed with multiple surveillance bronchoscopies.

Introduction

Fungal infections are a source of significant morbidity and mortality in paediatric oncology patients. We describe an unusual case of localised Aspergillus fumigatus infection of the larynx and tracheobronchial tree following bone marrow transplantation in a 6-year-old girl.

Section snippets

Case history

A 6-year-old girl with acute lymphoblastic leukaemia diagnosed at the age of four, underwent an unrelated cord blood transplant after relapsing whilst on treatment. Post transplant she had grade II graft versus host disease affecting the skin and gut. She was maintained on immunosuppressant therapy of oral cyclosporine adjusted to maintain serum level of 150–250 ng/ml and a slowly reducing course of oral prednisolone. Her other medications included prophylactic oral acyclovir 200 mg twice per

Discussion

We present a case of localized A. fumigatus infection of the larynx in a 6-year-old girl, 7 months following cord blood transplantation for acute lymphoblastic leukaemia. This case highlights the importance of thorough investigation of immunosuppressed patients presenting with symptoms of upper airways obstruction.

Fungal infections are common in paediatric oncology patients [1]. The most important risk factor for fungal infections is prolonged neutropenia [2]. Other recognized risk factors

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