Recognition and successful management in pulmonary aspergillosis in leukemia.

Invasive pulmonary aspergillosis is a common fungal infection in the compromised host. The outcome has been generally poor and, until recently, most reports are derived from autopsy series. We report nine patients with leukemia and the characteristic clinical presentation of pulmonary infarction. There is histological evidence that infarction is due to fungal invasion of the pulmonary arterial system with distal hemorrhagic infarction, cavitation, and mycetoma formation. This complete evolution was detected in six patients, none of whom had previous cavitary pulmonary disease. Therapy included amphotericin B (9 patients), aerosolized nystatin (6 patients), and 5-fluorocytosine (5 patients). Complete resolution of the pulmonary lesions occurred in six patients with a subsequent median survival of 13.5 months (range: 5-32+ months). Three patients died with continuing pulmonary infiltrate. Despite the antifungal chemotherapy, resolution seemed to correlate best with recovery of circulating neutrophils.