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Persistent Fever After Recovery From Granulocytopenia in Acute Leukemia
George H. Talbot, MD;
Mary Provencher, MT;
Peter A. Cassileth, MD
Arch Intern Med. 1988;148(1):129-135.
Abstract
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• We reviewed the hospital admissions of 168 patients with acute leukemia to determine the incidence of persistent fever following recovery from chemotherapy-induced granulocytopenia. This phenomenon was observed during 26 (15.5%) hospital admissions. The microbiologically and/or clinically documented causes identified in 23 instances included viral infection (two patients), perirectal abscess (two patients), Hickman catheter-related bacteremia (two patients), intraabdominal infection (four patients), and nine fungal infections (five resolving pneumonia, one disseminated candidiasis, three focal hepatic and/or splenic mycosis). One patient had both cholecystitis and a pneumonia of uncertain origin and three patients had drug reactions. Although overall the source of fever was usually readily apparent, focal hepatic and/or splenic mycosis produced protracted fevers that were difficult to diagnose. Visceral fungal infection should be a leading diagnostic consideration in patients with leukemia who remain persistently febrile following recovery from chemotherapy-induced granulocytopenia.
(Arch Intern Med 1988;148:129-135)
Author Affiliations
From the Sections of Infectious Diseases and Hematology-Oncology, Department of Medicine, University of Pennsylvania School of Medicine, and the Infection Control Section, Hospital of the University of Pennsylvania, Philadelphia.
Footnotes
Accepted for publication Sept 1, 1987.
Reprint requests to 1 Gibson Bldg, Hospital of the University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104 (Dr Talbot).
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