Salvage therapy of refractory chronic disseminated candidiasis in a patient with acute myeloid leukaemia and secondary prophylaxis during allogeneic stem cell transplantation.
We report on the treatment course of a 27-year-old male patient with acute myeloid leukaemia M1 and chronic disseminated candidiasis. After induction chemotherapy, the patient developed oesophageal candidiasis while participating in a voriconazole vs. placebo prophylaxis trial. He was then switched to oral fluconazole 400 mg q.i.d. After 6 days of futile fluconazole therapy he was switched to caspofungin 50 mg q.i.d. Caspofungin dose was later increased to 100 mg q.i.d after disseminated candidiasis with involvement of lung, spleen and liver was diagnosed. Following 63 days of caspofungin without resolution of symptoms, i.e. being persistently febrile, and emergence of soft tissue Candida abscesses, he was included into a trial allowing compassionate use of posaconazole as salvage therapy for refractory invasive fungal infections. Symptoms rapidly resolved under posaconazole 200 mg q.i.d. treatment and the patient was able to undergo allogeneic haematopoietic stem cell transplantation on secondary prophylaxis with posaconazole.
Vehreschild
Jörg J
JJ
1st Department of Internal Medicine, University of Cologne, Cologne, Germany.
Krüger
Karsten
K
Kurzai
Oliver
O
Wickenhauser
Claudia
C
Behringer
Karolin
K
Töx
Ulrich
U
Cornely
Oliver A
OA
D000328:Adult; D000935:Antifungal Agents / Q000627:therapeutic use*; D002177:Candidiasis / Q000188:drug therapy* / Q000382:microbiology; D018890:Chemoprevention; D025141:Drug Resistance, Fungal; D004941:Esophagitis / Q000188:drug therapy / Q000382:microbiology; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000150:complications*; D008297:Male; D009181:Mycoses / Q000517:prevention & control; D016879:Salvage Therapy; D033581:Stem Cell Transplantation / Q000009:adverse effects; D014184:Transplantation, Homologous / Q000009:adverse effects; D014230:Triazoles / Q000627:therapeutic use*
D000935:Antifungal Agents; D014230:Triazoles; C101425:posaconazole