Fungal splenic abscesses: management in childhood leukemia

Fungal splenic abscesses are a potentially fatal complication of childhood leukemia, especially during hematologic relapse. Optimal treatment requires splenectomy combined with amphotericin B therapy. Previous reports have suggested that splenectomy should not be performed prior to complete control of the relapse. Three children with relapsed acute lymphocytic leukemia developed fever and splenomegaly, two during the re-induction phase of chemotherapy and the third within 1 month after a second remission. Imaging studies revealed non-homogeneity of the spleen. Uneventful splenectomy was performed for both diagnostic and therapeutic purposes before the return of normal hematopoiesis. Our results indicate that splenectomy for treatment of fungal abscesses can be successfully undertaken before complete hematologic remission is accomplished.