Resolution of disseminated fusariosis in a child with acute leukemia treated with combined antifungal therapy: a case report.
BACKGROUND
Fusarium spp. is being isolated with increasing frequency as a pathogen in oncohematologic patients. Caspofungin and amphotericin B have been reported to have synergistic activity against Fusarium spp.


METHODS
We herein report a case of disseminated fusariosis diagnosed by chest CT scan and positive blood cultures to Fusarium spp. Because the patient's clinical condition deteriorated, CRP levels increased, and blood cultures continued to yield Fusarium spp. despite liposomal amphotericin B monotherapy up to 5 mg/kg daily, treatment with caspofungin was added. Within 2 weeks of onset of combined antifungal therapy, the chest CT scan demonstrated a progressive resolution of the pulmonary lesions. Upon discontinuation of intravenous antifungals, the patient received suppressive therapy with oral voriconazole. Three months later, a chest CT scan showed no abnormalities. Twenty-five months after discontinuation of all antifungal therapy, the patient remains in complete remission of her neoplastic disease with no signs of clinical activity of the Fusarium infection.


CONCLUSIONS
This is the first description of successful treatment of disseminated fusariosis in a pediatric patient with acute lymphoblastic leukemia with caspofungin and amphotericin B followed by oral suppressive therapy with voriconazole.
Vagace
José-Manuel
JM
Department of Hematology, Complejo Hospitalario Infanta Cristina, Badajoz, Spain. jvagacev@aehh.org
Sanz-Rodriguez
Cesar
C
Casado
Maria-Soledad
MS
Alonso
Nieves
N
Garcia-Dominguez
Manuel
M
de la Llana
Francisco Garcia
FG
Zarallo
Luis
L
Fajardo
Miguel
M
Bajo
Roberto
R
D000666:Amphotericin B / Q000008:administration & dosage / Q000627:therapeutic use*; D000935:Antifungal Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D000077336:Caspofungin; D002648:Child; D004359:Drug Therapy, Combination; D054714:Echinocandins; D005260:Female; D005670:Fusarium / Q000145:classification / Q000187:drug effects*; D006801:Humans; D055666:Lipopeptides; D009181:Mycoses / Q000150:complications / Q000188:drug therapy* / Q000382:microbiology; D010456:Peptides, Cyclic / Q000008:administration & dosage / Q000627:therapeutic use*; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications*; D011743:Pyrimidines / Q000008:administration & dosage / Q000627:therapeutic use; D016896:Treatment Outcome; D014230:Triazoles / Q000008:administration & dosage / Q000627:therapeutic use; D065819:Voriconazole
D000935:Antifungal Agents; D054714:Echinocandins; D055666:Lipopeptides; D010456:Peptides, Cyclic; D011743:Pyrimidines; D014230:Triazoles; D000666:Amphotericin B; D000077336:Caspofungin; D065819:Voriconazole