Acremonium strictum pulmonary infection in a leukemic patient successfully treated with posaconazole after failure of amphotericin B.
A severely neutropenic patient with chronic lymphocytic leukemia developed a diffuse bilateral pulmonary infection while receiving a therapeutic daily dosage of intravenous amphotericin B for Candida glabrata esophagitis. Computed tomography of the chest showed numerous lung nodules, ground glass areas and a pleural effusion. Biopsy of one nodule demonstrated hyaline septate hyphae. Multiple sputum cultures grew Acremonium strictum. Increasing the dose of amphotericin B and the addition of itraconazole did not resolve the infection. Change of treatment to posaconazole given orally at 200 mg four times/d resulted in progressive improvement leading finally to cure after 24 weeks of therapy. Treatment with posaconazole was clinically and biologically well tolerated.
Herbrecht
R
R
Département d'Hématologie et d'Oncologie, Hôpital de Hautepierre, Avenue Molière, 67098 Strasbourg, France. raoul.herbrecht@chru-strasbourg.fr
Letscher-Bru
V
V
Fohrer
C
C
Campos
F
F
Natarajan-Ame
S
S
Zamfir
A
A
Waller
J
J
D000164:Acremonium / Q000187:drug effects* / Q000302:isolation & purification*; D000284:Administration, Oral; D000666:Amphotericin B / Q000008:administration & dosage*; D000935:Antifungal Agents / Q000008:administration & dosage; D001707:Biopsy, Needle; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016867:Immunocompromised Host; D008172:Lung Diseases, Fungal / Q000175:diagnosis* / Q000188:drug therapy*; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications / Q000188:drug therapy / Q000276:immunology*; D018570:Risk Assessment; D014057:Tomography, X-Ray Computed; D017211:Treatment Failure; D016896:Treatment Outcome; D014230:Triazoles / Q000008:administration & dosage*
D000935:Antifungal Agents; D014230:Triazoles; C101425:posaconazole; D000666:Amphotericin B