Complications

Complications relate to site-specific manifestations of the disorder and/or consequences of treatment with chemotherapy or radiation. Infectious complications are common, most often following treatment of acute leukemia. The most feared are fungal infections, especially with Aspergillus species (68) or mucormycoses (69). The incidence increases with prolonged periods of neutropenia or with immunosuppression given for the treatment of graft versus host disease following allogeneic stem-cell transplantation. Disease may be localized to head and neck structures including the nose, paranasal sinuses, or orbits (Fig. 6), or may be present at systemic sites, most frequently, the lung parenchyma. Intracranial spread may occur from direct extension of the rhinocerebral form of mucormycosis but can be seen in other opportunistic fungal infections. Invasive fungal infections of the head and neck in this setting have a very high case fatality rate and treatment includes high-dose systemic antifungal agents and early, aggressive surgical debridement. In addition to early medical and surgical intervention, neutrophil recovery and withdrawal of immunosuppressive medications, when possible, gives the best chance for a successful outcome. Complications that are related to the specific site of disease involvement are discussed under "Clinical Manifestations," above.

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