Rapid improvement of disseminated aspergillosis with caspofungin/voriconazole combination in an adult leukemic patient.
A 57-year-old man with acute myeloid leukemia (AML) French-American-British (FAB) 4 developed disseminated invasive cerebral and pulmonary aspergillosis during postinduction aplasia. According to international consensus, infection was categorized as probable (two host factors: deep neutropenia for >10 days and refractory fever for >96 h; major clinical criteria of lower respiratory tract and CNS invasive fungal infection; positive results for galactomannan antigen in three blood samples). After the failure of standard amphotericin-based therapy, the spectacular regression of multifocal brain and lung lesions was rapidly achieved under a caspofungin acetate/voriconazole combination. Further permanent caspofungin maintenance with voriconazole added during aplasia periods permitted two consolidation courses and autograft-based intensification without any delay.
Damaj
G
G
Department of Hematology, Institute Paoli-Calmettes, 232, Boulevard Sainte Marguerite, B.P. 156, 13273, Marseille cedex 9, France.
Ivanov
V
V
Le Brigand
B
B
D'incan
E
E
Doglio
M F
MF
Bilger
K
K
Faucher
C
C
Vey
N
N
Gastaut
J A
JA
D000935:Antifungal Agents / Q000008:administration & dosage*; D001228:Aspergillosis / Q000000981:diagnostic imaging / Q000188:drug therapy*; D000077336:Caspofungin; D004359:Drug Therapy, Combination; D054714:Echinocandins; D006801:Humans; D015479:Leukemia, Myelomonocytic, Acute / Q000382:microbiology*; D055666:Lipopeptides; D008297:Male; D008875:Middle Aged; D010455:Peptides / Q000008:administration & dosage*; D010456:Peptides, Cyclic; D011743:Pyrimidines / Q000008:administration & dosage*; D011859:Radiography; D016896:Treatment Outcome; D014230:Triazoles / Q000008:administration & dosage*; D065819:Voriconazole
D000935:Antifungal Agents; D054714:Echinocandins; D055666:Lipopeptides; D010455:Peptides; D010456:Peptides, Cyclic; D011743:Pyrimidines; D014230:Triazoles; D000077336:Caspofungin; D065819:Voriconazole