January 1988

Persistent Fever After Recovery From Granulocytopenia in Acute Leukemia

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.

Arch Intern Med. 1988;148(1):129-135. doi:10.1001/archinte.1988.00380010131013

• 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)