Breakthrough invasive fungal infection under the use of posaconazole and voriconazole
Journal
Journal of the Formosan Medical Association
Journal Volume
115
Journal Issue
5
Pages
384-385
Date Issued
2016
Author(s)
Abstract
Wide-spread use of antifungal agents in hematopoietic stem cell transplantation (HSCT) recipients has led to increased incidence of mucormycosis and emergence of drug resistant fungi. We report the development of arthritis by a rare fungus, Colletotrichum coccodes, under posaconazole prophylaxis, probable voriconazole-resistant aspergillosis, and mucormycosis by Cunninghamella species in a HSCT recipient with protracted graft versus host disease (GvHD). A 60-year-old man with Stage IV peripheral T-cell lymphoma, underwent an allogeneic HSCT fromapartially human leukocyte antigen (HLA)-matched (8/10) sibling donor, after a reduced-intensity conditioning regimen consisting of fludarabine, cyclophosphamide, and total body irradiation. Antithymocyte globulin, cyclosporine, and mycophenolate mofetil were GvHD prophylaxis. Neutrophil engraftment was confirmed on Day 9 and post-transplant marrow examination revealed complete donor chimerism with nominimal residual disease. Over the next 2 months, several episodes of biopsyconfirmed GvHD of the gut developed, and pulse methylprednisolone and etanercept were given. Prophylactic posaconazole was administered and substituted with amphotericin B deoxycholate (AmBd) 1 month later when joint abscess developed over his second and third
SDGs
Other Subjects
amphotericin B deoxycholate; amphotericin B lipid complex; cyclophosphamide; cyclosporin; etanercept; fludarabine; galactomannan; methylprednisolone; mycophenolate mofetil; posaconazole; thymocyte antibody; voriconazole; antifungal agent; posaconazole; triazole derivative; voriconazole; abscess; adult; allogeneic hematopoietic stem cell transplantation; antibiotic prophylaxis; case report; chimera; Colletotrichum; Colletotrichum coccodes; computer assisted tomography; Cunninghamella; deterioration; drug substitution; drug treatment failure; drug withdrawal; engraftment; fungus growth; graft versus host reaction; hospital readmission; human; human tissue; kidney tubule acidosis; Letter; male; middle aged; minimum inhibitory concentration; multiple organ failure; neutrophil; peripheral T cell lymphoma; recurrent disease; reduced intensity conditioning; septic shock; sibling; systemic mycosis; tracheobronchial toilet; whole body radiation; complication; hematopoietic stem cell transplantation; Invasive Fungal Infections; isolation and purification; Lymphoma, T-Cell, Peripheral; multidrug resistance; Opportunistic Infections; Antifungal Agents; Colletotrichum; Drug Resistance, Multiple, Fungal; Hematopoietic Stem Cell Transplantation; Humans; Invasive Fungal Infections; Lymphoma, T-Cell, Peripheral; Male; Middle Aged; Opportunistic Infections; Triazoles; Voriconazole
Publisher
Elsevier B.V.
Type
journal article