Multiple pulmonary aspergillomas in acute leukemia

We present here a case of acute myelomonocytic leukemia treated with arabinosyl cytosine, long‐term broad spectrum antibiotics, and other supportive measures. The patient developed bilateral multiple pulmonary fungus balls almost simultaneously with a clinical and bone marrow remission of acute leukemia. The exact pathophysiology of these mycetomas is not clear, but the data are compatible with the hypotheses that the multiple mycetomas were preceded either by multiple pulmonary emboli with subsequent necrosis and infection or by multiple pulmonary hemorrhagic infarctions due to aspergillosis with subsequent aspergilloma formation. Neither alternative has been previously reported. The patient was treated with intravenous amphotericin B and aerosolized nystatin with resolution of the pulmonary lesions. Since the patient went into complete remission of the leukemia near the time of recognition of the aspergillosis, it is difficult to define the effect of the therapy on the pulmonary lesions.