RRC ID 47076
Author Shindo M, Sato K, Jimbo J, Hosoki T, Ikuta K, Sano A, Nishimura K, Torimoto Y, Kohgo Y.
Title [Breakthrough pulmonary mucormycosis during voriconazole treatment after reduced-intensity cord blood transplantation for a patient with acute myeloid leukemia].
Journal Rinsho Ketsueki
Abstract A 59-year-old man was admitted to our hospital with a diagnosis of acute myeloid leukemia in September 2004. He developed invasive pulmonary aspergillosis (IPA) and candidiasis, which were improved by administration of micafungin and amphotericin B (AMPH-B). He received reduced-intensity unrelated cord-blood transplantation without induction chemotherapy. He developed grade IV graft-versus-host disease (GVHD) and the administration of steroids against GVHD was prolonged. Voriconazole (VRCZ) was used for a long period to prevent recurrence of the IPA. Afterwards, infiltrates in the bilateral upper lung fields were detected on a chest CT scan, and a diagnosis of pulmonary mucormycosis was made following detection of Mucor circinelloides from the patient's sputum culture. He then began receiving AMPH-B but died of massive hemoptysis. Mucormycosis usually occurs in immunocompromised hosts such as neutropenic patients with hematologic diseases and is a fatal fungal infection characterized by a rapid and progressive clinical course. Some overseas investigators have recently reported that VRCZ prophylaxis may result in breakthrough mucormycosis in hematopoietic stem cell transplant recipients. These findings suggest that it is very important to pay attention to mucormycosis in hematopoietic stem cell transplant recipients in this country.
Volume 48(5)
Pages 412-7
Published 2007-5-1
PMID 17571588
MeSH Amphotericin B / therapeutic use Antifungal Agents / adverse effects* Antifungal Agents / therapeutic use Aspergillosis / prevention & control Cord Blood Stem Cell Transplantation* Echinocandins Fatal Outcome Graft vs Host Disease / drug therapy Humans Immunocompromised Host* Immunosuppressive Agents / adverse effects* Leukemia, Myeloid, Acute / therapy* Lipopeptides Lipoproteins / therapeutic use Lung Diseases, Fungal / etiology* Lung Diseases, Fungal / prevention & control Male Micafungin Middle Aged Mucormycosis / etiology* Peptides, Cyclic / therapeutic use Pyrimidines / adverse effects* Transplantation Conditioning* Triazoles / adverse effects* Voriconazole
Pathogenic microorganisms