title: Clinical efficacy and tolerability of caspofungin in a renal transplant patient with Aspergillus flavus lung infection: case report.
abstract: Organ transplant recipients are at increased risk for severe invasive aspergillosis, and amphotericin deoxycholate has been the standard treatment for many years. Currently, however, lipid formulations are preferred due to their few side effects. Also, a number of new antifungal drugs have been developed including new azoles and echinocandins. Caspofungin is the first of the echinocandin derivatives patented to treat patients with invasive aspergillosis who are refractory or intolerant to other therapies. A renal transplant patient on immunosuppressive treatment with chronic hepatitis B virus infection was admitted with fever, hemophthisis and lung consolidation, diagnosed to be probably caused by Aspergillus flavus. The patient developed cholestatic hepatitis most likely related to itraconazole. Clinical failure and in vitro itraconazole resistance of the isolate was also documented while the patient was receiving itraconazole at a reduced dosage. Caspofungin was administered once a day as ambulatory treatment and was well tolerated. Clinical improvement was observed after 6 weeks of treatment and no hepatic toxicity was documented. Caspofungin seems to be a potentially useful antifungal agent in renal transplant patients with invasive aspergillosis. Further evaluation of the efficacy of caspofungin is needed.
authors.affiliation: Clinica di Malattie Infettive, Dipartimento Medicina Sperimentale e Scienze Biochimiche, Università di Perugia, Perugia, Italy. pasticci@unipg.it
authors.forename: M B
authors.initials: MB
authors.lastname: Pasticci
authors.forename: F
authors.initials: F
authors.lastname: Barchiesi
authors.forename: S
authors.initials: S
authors.lastname: Fallani
authors.forename: N
authors.initials: N
authors.lastname: Palladino
authors.forename: L M
authors.initials: LM
authors.lastname: Lapalorcia
authors.forename: M
authors.initials: M
authors.lastname: Gubbiotti
authors.forename: M
authors.initials: M
authors.lastname: Cozzari
authors.forename: A
authors.initials: A
authors.lastname: Novelli
authors.forename: F
authors.initials: F
authors.lastname: Baldelli
mesh_terms: D000935:Antifungal Agents / Q000627:therapeutic use; D001228:Aspergillosis / Q000188:drug therapy*; D001231:Aspergillus flavus; D000077336:Caspofungin; D054714:Echinocandins; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects*; D055666:Lipopeptides; D008168:Lung / Q000000981:diagnostic imaging; D008172:Lung Diseases, Fungal / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D010456:Peptides, Cyclic / Q000627:therapeutic use*; D011859:Radiography
chemical_list: D000935:Antifungal Agents; D054714:Echinocandins; D055666:Lipopeptides; D010456:Peptides, Cyclic; D000077336:Caspofungin