THE USE of intensive chemotherapy for patients with hematologic neoplasia has produced a rapidly growing population of immunosuppressed patients at high risk for opportunistic infections. Until recently, only one case of infection with the aerobic, Gram-positive, spore-forming rods of the genus Bacillus has been reported in this group of patients.1 Since 1971, however, Bacillus species infection has been reported in three such patients,2,3 all with fatal outcome. None of these Bacillus species were B anthracis. The present report identifies two further cases of fatal Bacillus infection in patients with hematologic neoplasia and outlines some important clinical considerations when this organism is encountered.
Report of Cases
A 56-year-old woman with leukemic reticuloendotheliosis was admitted to the Peter Bent Brigham Hospital because of a fever and cough of two days' duration. Current medications were cyclophosphamide and prednisone. On physical examination, her temperature was 38.6 C, she appeared dyspneic,