Fluctuations in serum antigens and antibodies in a patient with primary cutaneous aspergillosis associated with acute leukemia

A 5-year-old girl developed cutaneous aspergillosis due to Aspergillus flavus while undergoing remission induction therapy for acute lymphocytic leukemia. Of six serum samples obtained during the acute stage of Aspergillus infection, four showed antigenemia (6.5-22.9 ng/ml) determined by enzyme-linked immunosorbent assay (ELISA). However, five serum samples obtained after treatment with amphotericin B and granulocyte-colony stimulating factor showed negative results for antigens. Sera obtained on day 17 after the detection of skin lesions showed seroconversion in precipitin antibody determined by an immunodiffusion test and in immunoglobulin (Ig) A class antibody determined by ELISA, while sera obtained on day 24 showed seroconversion of IgG and IgM class antibodies. The patient achieved complete remission of leukemia and was discharged on the 92nd day of hospitalization. No signs of disseminated or deep-seated fungal infections were present during the hospitalization. Assays for serum antigens may be of value for the early diagnosis of invasive aspergillosis. Moreover, persistently negative results for antigens in accordance with antibody responses may correlate with recovery from the infection.