title: Resistant Microascus cirrosus pneumonia can be treated with a combination of surgery, multiple anti-fungal agents and a growth factor.
abstract: A 49-year old male with acute myelogenous leukemia relapsed eight years post allogeneic bone marrow transplantation. The patient received induction chemotherapy causing prolonged neutropenia. The patient developed pneumonia for which empirical antibacterial and antifungal therapy were started. The patient underwent a video-assisted thorocascopy with near complete resection of the lesion because of poor response to treatment. Microascus cirrosus was identified in the tissue. In vitro susceptibility test to different antifungal agents showed M. cirrosus was very resistant. The patient is undergoing second allogeneic transplant with improved pneumonia resulting from a combination of treatment for fungal infection, which included surgery, antifungal agents, and granulocyte-colony stimulating factor. The Microascus genus rarely causes invasive fungal infection in humans and can be very difficult to treat because of the resistance to available antifungal agents.
authors.affiliation: The Department of Internal Medicine, Section of Hematology/Oncology, Medical College of Georgia, 1120 15th Street, BAA-5407, Augusta, GA 30912-3125, USA. custun@mail.mcg.edu
authors.forename: Celalettin
authors.initials: C
authors.lastname: Ustun
authors.forename: Gerwin
authors.initials: G
authors.lastname: Huls
authors.forename: Marc
authors.initials: M
authors.lastname: Stewart
authors.forename: Kieren A
authors.initials: KA
authors.lastname: Marr
mesh_terms: D000935:Antifungal Agents / Q000627:therapeutic use*; D001203:Ascomycota; D016026:Bone Marrow Transplantation; D003131:Combined Modality Therapy; D016179:Granulocyte Colony-Stimulating Factor / Q000627:therapeutic use*; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000382:microbiology; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000188:drug therapy / Q000382:microbiology / Q000601:surgery / Q000628:therapy*; D011014:Pneumonia / Q000188:drug therapy / Q000382:microbiology* / Q000601:surgery / Q000628:therapy*; D014184:Transplantation, Homologous
chemical_list: D000935:Antifungal Agents; D016179:Granulocyte Colony-Stimulating Factor