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Metarrhizium anisopliae is a common insect pathogen that rarely causes infection in animals and humans. We report the first case of a disseminated skin infection in an immunocompromised adult patient. To date, only five cases of the disease in humans have been reported. There is no standard treatment for this infection. CASE REPORTA 62-year-old male presented in April 2005 with fever and malaise. Blood counts revealed pancytopenia with 330 neutrophils/l and 65% blasts. A bone marrow aspirate established a diagnosis of acute myelogenous leukemia (M2) with a normal cytogenetic study. He received induction chemotherapy with idarrubicine (12 mg/m 2 ϫ 3 days) and cytarabine (200 mg/m 2 ϫ 7 days). The first day of chemotherapy was designated day 0. Because of the persistence of blasts in the bone marrow, further treatment with mitoxantrone (10 mg/m 2 ϫ 3 days) and cytarabine (400 mg/m 2 ϫ 5 days) was given. Prophylactic fluconazole was administered from day ϩ3 after induction chemotherapy until day ϩ39. A brief episode of fever of unknown origin developed between days ϩ3 and ϩ7 and was treated empirically with imipenem. On day ϩ42 after induction chemotherapy, maculopapular skin lesions appeared, disseminating in 48 h and involving the face, trunk, and limbs (up to 42 papules with central ulceration were counted). Some of the lesions resembled ecthyma gangrenosum. A skin biopsy sample showed dermoepidermic necrolysis and fibrin thrombi. No cultures were obtained at the time. The clinical picture was considered to be compatible with a septic process, although a toxic epidermal necrolysis was also possible. When the skin lesions appeared, the patient was neutropenic and was receiving empirical antimicrobial therapy with imipenem and teicoplanin. From day ϩ39 after induction chemotherapy, the patient was started on caspofungin because of a relapsing neutropenic fever. Four days later, he became afebrile and his neutrophil count increased to more than 500/l. Caspofungin and antibiotics were withheld, and the patient was discharged on day ϩ50 after induction chemotherapy without any antifungal drug. The skin lesions gradually improved.Two more consolidation chemotherapy cycles were administered in June and August 2005 (23 mg idarrubicine ϫ 2 days and 390 mg cytarabine ϫ 5 days in both cycles). No fever or skin lesions appeared, and no antifungal therapy was administered during the first consolidation chemotherapy. Two new skin lesions identical to the previous ones appeared on day ϩ10 after the second consolidation cycle, before he became neutropenic on day ϩ12. Because of the appearance of these lesions, fluconazole was started on day ϩ10 and maintained until day ϩ28 after consolidation chemotherapy, when the patient was discharged. The lesions gradually disappeared.In September and October 2005, the patient's leukemia was in complete remission and his peripheral blood counts were normal. During this period of time, while the patient was waiting for autologous stem cell transplantation (SCT), a new flare-up of disseminate...

The surface expression of CD79b, using the monoclonal antibody (Mab) CB3-1, on B lymphocytes from normal individuals and patients with B cell chronic lymphocytic leukemia (CLL) has been analyzed using triple-staining cells for flow cytometry. In addition, the clinical significance of CD79b expression in CLL patients and its possible value for the evaluation of minimal residual disease (

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