title: Successful combined antifungal salvage therapy with liposomal amphothericin B and caspofungin for invasive Aspergillus flavus infection in a child following allogeneic bone marrow transplantation.
abstract: The emergence of new antifungal compounds with alternative mechanisms of action and improved tolerability has opened up new therapeutic possibilities for the use of combined antifungal treatment in life-threatening systemic fungal infections. A case report of an 8-year-old allogeneic stem cell transplant recipient who developed a central venous catheter tunnel infection caused by Aspergillus flavus is presented here. In spite of conventional and subsequent liposomal amphotericin B therapy the infection progressed rapidly and the necrosis extended further to the thoracic wall, pleura and the right lung. Combined treatment consisting of liposomal amphotericin B and caspofungin was instituted. After 30 days of dual therapy the deep fungal infection resolved and the extensive soft tissue defect showed scarring. One year post-transplant, the patient is well, with normal bone marrow function and full donor chimerism. Although there is limited clinical data on the effectiveness of echinocandins in pediatric patients with documented invasive fungal infections, this case report shows that combining liposomal amphotericin B with caspofungin could be advantageous.
authors.affiliation: Bone Marrow Transplantation Unit, Szent László Hospital, Budapest, Hungary. krivang@hu.inter.net
authors.forename: Gergely
authors.initials: G
authors.lastname: Kriván
authors.forename: János
authors.initials: J
authors.lastname: Sinkó
authors.forename: Ildikó Zsolnai
authors.initials: IZ
authors.lastname: Nagy
authors.forename: Vera
authors.initials: V
authors.lastname: Goda
authors.forename: Péter
authors.initials: P
authors.lastname: Reményi
authors.forename: Arpád
authors.initials: A
authors.lastname: Bátai
authors.forename: Sándor
authors.initials: S
authors.lastname: Lueff
authors.forename: Balázs
authors.initials: B
authors.lastname: Kapás
authors.forename: Marienn
authors.initials: M
authors.lastname: Réti
authors.forename: Anna
authors.initials: A
authors.lastname: Tremmel
authors.forename: Tamás
authors.initials: T
authors.lastname: Masszi
mesh_terms: D000666:Amphotericin B / Q000008:administration & dosage / Q000627:therapeutic use*; D000741:Anemia, Aplastic / Q000209:etiology / Q000601:surgery; D000935:Antifungal Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001228:Aspergillosis / Q000188:drug therapy*; D001231:Aspergillus flavus / Q000302:isolation & purification*; D016026:Bone Marrow Transplantation; D000077336:Caspofungin; D002405:Catheterization, Central Venous / Q000009:adverse effects; D002648:Child; D002921:Cicatrix / Q000209:etiology; D018450:Disease Progression; D004357:Drug Synergism; D004359:Drug Therapy, Combination; D054714:Echinocandins; D004866:Equipment Contamination; D005260:Female; D006505:Hepatitis / Q000150:complications; D006801:Humans; D016867:Immunocompromised Host; D017708:Leukocyte Transfusion; D055666:Lipopeptides; D008081:Liposomes; D009336:Necrosis; D010456:Peptides, Cyclic / Q000008:administration & dosage / Q000627:therapeutic use*; D011030:Pneumothorax / Q000150:complications; D011183:Postoperative Complications / Q000188:drug therapy*; D012074:Remission Induction; D016879:Salvage Therapy; D022783:Torque teno virus / Q000302:isolation & purification; D014184:Transplantation, Homologous
chemical_list: D000935:Antifungal Agents; D054714:Echinocandins; D055666:Lipopeptides; D008081:Liposomes; D010456:Peptides, Cyclic; C068538:liposomal amphotericin B; D000666:Amphotericin B; D000077336:Caspofungin