title: [Successful treatment with voriconazole for disseminated cutaneous and visceral infection by Fusarium solani in a patient with acute myeloid leukemia].
abstract: We report the successful treatment of a disseminated Fusarium infection with skin manifestations in a severely neutropenic patient. A 51-year-old man with acute myeloblastic leukemia (M4) underwent two courses of remission induction therapy with cytarabine and daunorubicin. Despite prophylactic treatment with tosufloxacin and micafungin, the patient developed a febrile scrotal ulcer. Eight days later, we noted the appearance of painful and diffuse cutaneous nodules and a plain chest X-ray disclosed multiple nodular lesions. Microbiological examination of the scrotal ulcer revealed infection by Fusarium solani, which was also confirmed by both histological and microbiological examination of the skin nodules. Although the patient was treated with amphotericin B (AMPH-B), the clinical symptoms worsened. After AMPH-B was replaced with voriconazole (VRCZ), the patient's symptoms and chest radiographic findings dramatically improved. Thus, VRCZ might be an alternative therapy for patients with neutropenia who have fusariosis that is refractory or unresponsive to AMPH-B.
authors.affiliation: Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital.
authors.forename: Takashi
authors.initials: T
authors.lastname: Muramatsu
authors.forename: Toshimitsu
authors.initials: T
authors.lastname: Ueki
authors.forename: Kazuteru
authors.initials: K
authors.lastname: Ohashi
authors.forename: Kumiko
authors.initials: K
authors.lastname: Negishi
authors.forename: Tomokazu
authors.initials: T
authors.lastname: Suzuki
authors.forename: Minori
authors.initials: M
authors.lastname: Shitara
authors.forename: Misao
authors.initials: M
authors.lastname: Honma
authors.forename: Tateki
authors.initials: T
authors.lastname: Ito
authors.forename: Miwa
authors.initials: M
authors.lastname: Sakai
authors.forename: Takuya
authors.initials: T
authors.lastname: Yamashita
authors.forename: Hideki
authors.initials: H
authors.lastname: Akiyama
authors.forename: Hisashi
authors.initials: H
authors.lastname: Sakamaki
mesh_terms: D000935:Antifungal Agents / Q000627:therapeutic use*; D003881:Dermatomycoses / Q000150:complications* / Q000188:drug therapy*; D005670:Fusarium; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000150:complications*; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000150:complications* / Q000188:drug therapy*; D009894:Opportunistic Infections / Q000150:complications* / Q000188:drug therapy*; D011743:Pyrimidines / Q000627:therapeutic use*; D016896:Treatment Outcome; D014230:Triazoles / Q000627:therapeutic use*; D065819:Voriconazole
chemical_list: D000935:Antifungal Agents; D011743:Pyrimidines; D014230:Triazoles; D065819:Voriconazole