Treatment of cavitary pulmonary zygomycosis with surgical resection and posaconazole.
We describe a 57-year-old woman with acute lymphoblastic leukemia who had a cavitary lesion develop in the right upper lobe caused by Cunninghamella bertholletiae, a zygomycete. The infection was resistant to both high-dose liposomal amphotericin B and voriconazole. The current report demonstrates successful treatment, even in the setting of subsequent bone marrow transplantation and immunosuppression, using a combination of surgical resection and posaconazole therapy.
Paul
Subroto
S
Division of Thoracic Surgery, and Department of Surgery, Brigham & Women's Hospital, Boston, Massachusetts 02115, USA.
Marty
Francisco M
FM
Colson
Yolonda L
YL
D000666:Amphotericin B / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use; D001215:Asparaginase / Q000008:administration & dosage / Q000009:adverse effects; D001549:Benzamides; D016026:Bone Marrow Transplantation; D000077723:Cefepime; D002511:Cephalosporins / Q000627:therapeutic use; D003131:Combined Modality Therapy; D020093:Cunninghamella / Q000302:isolation & purification*; D003630:Daunorubicin / Q000008:administration & dosage / Q000009:adverse effects; D026141:Drug Resistance, Multiple, Fungal; D005260:Female; D006801:Humans; D000068877:Imatinib Mesylate; D016867:Immunocompromised Host; D008172:Lung Diseases, Fungal / Q000188:drug therapy / Q000382:microbiology / Q000601:surgery*; D008875:Middle Aged; D009503:Neutropenia / Q000139:chemically induced; D010879:Piperazines / Q000008:administration & dosage / Q000009:adverse effects; D011013:Pneumonectomy; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications / Q000188:drug therapy / Q000601:surgery; D011241:Prednisone / Q000008:administration & dosage / Q000009:adverse effects; D011743:Pyrimidines / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D019172:Transplantation Conditioning / Q000009:adverse effects; D014230:Triazoles / Q000627:therapeutic use*; D014640:Vancomycin / Q000627:therapeutic use; D014750:Vincristine / Q000008:administration & dosage / Q000009:adverse effects; D065819:Voriconazole; D020096:Zygomycosis / Q000188:drug therapy / Q000382:microbiology / Q000601:surgery*
D000935:Antifungal Agents; D001549:Benzamides; D002511:Cephalosporins; D010879:Piperazines; D011743:Pyrimidines; D014230:Triazoles; C068538:liposomal amphotericin B; D014750:Vincristine; D014640:Vancomycin; C101425:posaconazole; D000666:Amphotericin B; D000077723:Cefepime; D000068877:Imatinib Mesylate; D001215:Asparaginase; D065819:Voriconazole; D011241:Prednisone; D003630:Daunorubicin