Successful treatment of disseminated aspergillosis with the combination of voriconazole, caspofungin, granulocyte transfusions, and surgery followed by allogeneic blood stem cell transplantation in a patient with primary failure of an autologous stem cell graft.
The treatment of disseminated aspergillus infections in neutropenic patients remains a major challenge in spite of several new antifungal drugs. We report the case of a patient with multiple myeloma in prolonged neutropenia after primary failure of an autologous stem cell graft who developed invasive aspergillosis despite voriconazole monotherapy. He responded to a combination of voriconazole and caspofungin, supported by granulocyte transfusions and surgery. A subsequent allogeneic peripheral blood stem cell transplantation did not lead to recurring aspergillus infection. The patient is well and free of clinical disease with respect to the fungal infection and myeloma more than 18 months after the allogeneic transplantation.
Dinser
Robert
R
Medizinische Klinik I, Universitätsklinikum des Saarlandes, Homburg, Germany.
Grgic
Aleksandar
A
Kim
Yoo-Jin
YJ
Pfreundschuh
Michael
M
Schubert
Jörg
J
D000935:Antifungal Agents / Q000627:therapeutic use; D001228:Aspergillosis / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000473:pathology / Q000628:therapy*; D000077336:Caspofungin; D004359:Drug Therapy, Combination; D054714:Echinocandins; D006098:Granulocytes / Q000637:transplantation*; D006801:Humans; D017708:Leukocyte Transfusion; D055666:Lipopeptides; D008279:Magnetic Resonance Imaging; D008297:Male; D008558:Melphalan / Q000627:therapeutic use; D008875:Middle Aged; D009101:Multiple Myeloma / Q000150:complications / Q000628:therapy; D009336:Necrosis; D010456:Peptides, Cyclic / Q000627:therapeutic use*; D011743:Pyrimidines / Q000627:therapeutic use*; D011859:Radiography; D033581:Stem Cell Transplantation; D014182:Transplantation, Autologous; D014184:Transplantation, Homologous; D014230:Triazoles / Q000627:therapeutic use*; D065819:Voriconazole
D000935:Antifungal Agents; D054714:Echinocandins; D055666:Lipopeptides; D010456:Peptides, Cyclic; D011743:Pyrimidines; D014230:Triazoles; D000077336:Caspofungin; D065819:Voriconazole; D008558:Melphalan