Early Detection of Fungal Infection in an Immunosuppressed Patient Demonstrated by Thorax CT: Suspicion is the Best Marker!

6-year-old man with acute lymphoblastic leukemia developed neutropenic fever 12 days after induction chemotherapy. The focus of infection could not be found by clinical examination, chest radiography and routine cultures and em-piric antimicrobial treatment was started. As the fever persisted, computerized tomography (CT) of the thorax was performed, and a nodule with a diameter of 2 mm in the upper lobe of the right lung was detected (Fig 1 & 2). Absence of the lesion in the previous CT led us to think about a possible focus of infection. A follow-up CT taken one week later revealed that the size of nodule increased rapidly and reached a diameter of 13 mm (Fig 3). Fungal infection, especially angioinvasive aspergillosis, was considered in the differential diagnosis. A galactomannan index level of 2.0 in the bronchoalveolar lavage fluid further supported the radiological diagnosis. After antifungal treatment, including liposomal amphotericin B, the focus of infection re-gressed (Fig 4). The patient was discharged with the regression of fever and neutropenia. The findings of chest radiographs are seldom specific for the detection of a particular pathogen in the