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Acute myeloid leukaemia with tell-tale computed tomography scans
  1. S A W Fadilaha,
  2. S K Cheonga,
  3. A Maimunahb,
  4. S T Tohb,
  5. A S Shaminc
  1. aMAKNA-HUKM Cancer Institute, Hospital Universiti Kebangsaan Malaysia, Department of Haematology and Transplantation, bDepartment of Radiology, cDepartment of Microbiology
  1. Associate Professor Dr Fadilah S Abdul Wahid, Department of Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia (UKM), Jalan Yaacob Latif, Bandar Tun Razak, 56000 Kuala Lumpur, Malaysiasfadilah{at}mail.hukm.ukm.my

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Answers on p 737.

A 36 year old man with acute myeloid leukaemia presented with recurrent episodes of fever and a three day history of right sided pleuritic pain and left upper abdominal pain after two cycles of chemotherapy. The patient had received several broad spectrum antibiotics with no clinical improvement. On examination, his temperature was 40.2°C and there was no evidence of Hickman catheter infection both in terms of local evidence and catheter blood cultures. Coarse crackles were noted over the base of the right lung. The liver, spleen, and peripheral lymph nodes were not enlarged. Bone marrow examination showed hypocellular marrow with no excess of blast cells. The neutrophil count was less than 0.05 × 109/l for three weeks. Cultures of the blood were repeatedly negative. Chest radiography after two courses of chemotherapy was normal. Computed tomograms of the thorax and abdomen are shown in figs 1 and2.

Figure 1

Computed tomogram of the thorax.

Figure 2

Computed tomogram of the liver and spleen

Questions

(1) What do the computed tomograms show?

(2)
What is the most likely cause of the persistent fever in this patient and how would you confirm the diagnosis?
(3)
What is the treatment for this condition?

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