[Breakthrough pulmonary mucormycosis during voriconazole treatment after reduced-intensity cord blood transplantation for a patient with acute myeloid leukemia].
A 59-year-old man was admitted to our hospital with a diagnosis of acute myeloid leukemia in September 2004. He developed invasive pulmonary aspergillosis (IPA) and candidiasis, which were improved by administration of micafungin and amphotericin B (AMPH-B). He received reduced-intensity unrelated cord-blood transplantation without induction chemotherapy. He developed grade IV graft-versus-host disease (GVHD) and the administration of steroids against GVHD was prolonged. Voriconazole (VRCZ) was used for a long period to prevent recurrence of the IPA. Afterwards, infiltrates in the bilateral upper lung fields were detected on a chest CT scan, and a diagnosis of pulmonary mucormycosis was made following detection of Mucor circinelloides from the patient's sputum culture. He then began receiving AMPH-B but died of massive hemoptysis. Mucormycosis usually occurs in immunocompromised hosts such as neutropenic patients with hematologic diseases and is a fatal fungal infection characterized by a rapid and progressive clinical course. Some overseas investigators have recently reported that VRCZ prophylaxis may result in breakthrough mucormycosis in hematopoietic stem cell transplant recipients. These findings suggest that it is very important to pay attention to mucormycosis in hematopoietic stem cell transplant recipients in this country.
Shindo
Motohiro
M
Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical College.
Sato
Kazuya
K
Jimbo
Junko
J
Hosoki
Takaaki
T
Ikuta
Katsuya
K
Sano
Ayako
A
Nishimura
Kazuko
K
Torimoto
Yoshihiro
Y
Kohgo
Yutaka
Y
D000666:Amphotericin B / Q000627:therapeutic use; D000935:Antifungal Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001228:Aspergillosis / Q000517:prevention & control; D036101:Cord Blood Stem Cell Transplantation; D054714:Echinocandins; D017809:Fatal Outcome; D006086:Graft vs Host Disease / Q000188:drug therapy; D006801:Humans; D016867:Immunocompromised Host; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D015470:Leukemia, Myeloid, Acute / Q000628:therapy*; D055666:Lipopeptides; D008074:Lipoproteins / Q000627:therapeutic use; D008172:Lung Diseases, Fungal / Q000209:etiology* / Q000517:prevention & control; D008297:Male; D000077551:Micafungin; D008875:Middle Aged; D009091:Mucormycosis / Q000209:etiology*; D010456:Peptides, Cyclic / Q000627:therapeutic use; D011743:Pyrimidines / Q000009:adverse effects*; D019172:Transplantation Conditioning; D014230:Triazoles / Q000009:adverse effects*; D065819:Voriconazole
D000935:Antifungal Agents; D054714:Echinocandins; D007166:Immunosuppressive Agents; D055666:Lipopeptides; D008074:Lipoproteins; D010456:Peptides, Cyclic; D011743:Pyrimidines; D014230:Triazoles; D000666:Amphotericin B; D065819:Voriconazole; D000077551:Micafungin