Multiple debulking surgery and triple antifungal therapy in abdominal-cardiac-pulmonary invasive aspergillosis

Children with acute leukemia are at a high risk of invasive fungal disease, which might manifest itself as clinically-resistant entity. The objective of this paper is to present an unusual clinical case of 17-year-old patient treated for acute lymphoblastic leukemia, with early development of disseminated invasive aspergillosis, involving the abdominal, pulmonary and cardiac structures. The patient was subjected to a combined targeted double, and later triple, antifungal therapy together with several debulking surgical interventions. The clinical course indicated a highly clinically-resistant invasive fungal disease, and the treatment was unsuccessful in this case. Limited current experience in triple antifungal therapy, abdominal aspergillosis, Aspergillus endocarditis, and possible causes of failure of antifungal therapy are discussed in the paper.