Figure 4
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Prepared by...
Virat Sirisanthana, M.D. |
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Department of Pediatrics,
Chiang Mai University
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A
13-year-old boy was admitted because of fever, anemia, hepatosplenomegaly
and multiple
petechial hemorrhages. The bone marrow aspiration revealed many myeloblasts and monoblasts. He was diagnosed as AML (M4) and was given induction chemotherapy, consisted of vincristine, prednisolone, adriamycin and cytosine arabinoside for two weeks. He developed febril neutropenia (absolute neutrophil count 450/mm3) and was given intravenous penicillin, ceftazidime and amikacin. While he was on these three antibiotics he developed generalized erythematous papules with hemorrhagic spots on top as in figure 1,2. His absolute neutrophil count at that time was 0. The diagram of further course is in figure 4. |
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Figure 4
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Skin
scraping Gram's and Wright's stain revealed no organism. Hemoculture on
day three of
fever showed no organism. Urine culture on day 3 of fever grew Candida tropicalis. Discharge from skin lesion on day 10 of fever grew Candida tropicalis. On day 13 of fever infected hematoma was noticed at his back which drained out pus. Wright's stain from the pus also showed pseudohyphae and budding yeast cells. The pus culture and also hemoculture revealed Candida tropicalis. The patient was given imipenem, amikacin and amphotericin B. |
| Subsiding of
fever and healing of his skin lesions gradually occurred after his neutrophils
started climbing up. |
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Final
diagnosis : Disseminated Candida
Tropicalis infection in febrile neutropenic boy.
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