Brain Abscess Following CPX-351 Treatment in a Patient With Acute Myeloid Leukemia.

We describe a rare case of a brain abscess occurring during CPX-351 induction therapy for acute myeloid leukemia (AML). The patient experienced recurrent febrile neutropenia during the myelosuppression period and developed left-sided spatial neglect during hematologic recovery. Brain magnetic resonance imaging revealed a solitary abscess in the right parietal lobe. Burr hole drainage yielded Bacillus species, and subsequent treatment with vancomycin and linezolid, followed by endoscopic abscess resection, led to gradual neurological recovery. Complete remission of AML was achieved, and consolidation therapy with venetoclax plus azacitidine was initiated. CPX-351 is associated with prolonged myelosuppression and relatively low gastrointestinal toxicity, which may reduce the risk of Gram-negative sepsis but increase susceptibility to Gram-positive infections, such as catheter-related bacteremia. Clinicians should consider the possibility of a brain abscess in patients presenting with neurological symptoms during AML treatment, as early diagnosis and prompt surgical and antimicrobial management are critical for favorable outcomes.