title: Failure of voriconazole to cure disseminated zygomycosis in an immunocompromised child.
abstract: Voriconazole is increasingly used as a first-line agent for empirical antifungal therapy of prolonged febrile neutropenia in paediatric cancer patients. We describe the case of a 9-year-old patient with stage IV Burkitt lymphoma, who developed pulmonary and splenic zygomycosis while receiving voriconazole for persistent febrile neutropenia. The causative agent, Absidia corymbifera, was identified by broad-range fungal PCR in a lung biopsy sample. The patient was successfully treated with a combination of partial resection of the left upper lobe and antifungal therapy with high-dose liposomal amphotericin B followed by oral itraconazole as demonstrated by resolving pulmonary infiltrates on serial high resolution CT scans.
  
  
  CONCLUSIONS
  This case emphasises that the lack of in vitro activity of voriconazole against zygomycetes is clinically relevant. Failure of voriconazole in suspected fungal infection should be investigated for the possibility of zygomycosis. Broad-range polymerase chain reaction may be able to identify the causative organism when cultures remain sterile.
authors.affiliation: Department of Paediatrics, University of Bern, Inselspital, 3010 Bern, Switzerland.
authors.forename: Nicole
authors.initials: N
authors.lastname: Ritz
authors.forename: Roland A
authors.initials: RA
authors.lastname: Ammann
authors.forename: Carmen Casaulta
authors.initials: CC
authors.lastname: Aebischer
authors.forename: Mathias
authors.initials: M
authors.lastname: Gugger
authors.forename: Katia
authors.initials: K
authors.lastname: Jaton
authors.forename: Ralph A
authors.initials: RA
authors.lastname: Schmid
authors.forename: Christoph
authors.initials: C
authors.lastname: Aebi
mesh_terms: D020095:Absidia / Q000187:drug effects / Q000302:isolation & purification* / Q000472:pathogenicity; D000935:Antifungal Agents / Q000627:therapeutic use*; D002648:Child; D025141:Drug Resistance, Fungal; D005260:Female; D006801:Humans; D009503:Neutropenia / Q000150:complications / Q000188:drug therapy*; D049268:Positron-Emission Tomography; D011743:Pyrimidines / Q000627:therapeutic use*; D014230:Triazoles / Q000627:therapeutic use*; D065819:Voriconazole; D020096:Zygomycosis / Q000188:drug therapy / Q000209:etiology*
chemical_list: D000935:Antifungal Agents; D011743:Pyrimidines; D014230:Triazoles; D065819:Voriconazole