title: Breakthrough Scedosporium prolificans infection while receiving voriconazole prophylaxis in an allogeneic stem cell transplant recipient.
abstract: Breakthrough invasive fungal infections among patients with hematologic malignancies receiving voriconazole are being reported with increasing frequency, with zygomycete infections predominating. We report a case of disseminated Scedosporium prolificans infection in a patient receiving voriconazole prophylaxis. Despite poor in vitro activity of voriconazole for this organism, synergy studies using the checkerboard method demonstrated synergy with the combination of voriconazole and terbinafine. This regimen, in conjunction with central venous line removal and intravitreal voriconazole, contributed to the recovery of the patient. S. prolificans is a life-threatening mold that should be considered in patients with breakthrough invasive fungal infections while on voriconazole prophylaxis.
authors.affiliation: Victorian Infectious Diseases Service, Department of Microbiology, Royal Melbourne Hospital, Melbourne, Australia. tongsyc@gmail.com
authors.forename: S Y C
authors.initials: SY
authors.lastname: Tong
authors.forename: A Y
authors.initials: AY
authors.lastname: Peleg
authors.forename: J
authors.initials: J
authors.lastname: Yoong
authors.forename: R
authors.initials: R
authors.lastname: Handke
authors.forename: J
authors.initials: J
authors.lastname: Szer
authors.forename: M
authors.initials: M
authors.lastname: Slavin
mesh_terms: D000935:Antifungal Agents / Q000627:therapeutic use*; D004357:Drug Synergism; D006086:Graft vs Host Disease / Q000276:immunology; D006801:Humans; D016867:Immunocompromised Host; D007165:Immunosuppression Therapy; D008297:Male; D008875:Middle Aged; D008271:Mycetoma / Q000188:drug therapy / Q000276:immunology* / Q000517:prevention & control; D009281:Naphthalenes / Q000627:therapeutic use; D011743:Pyrimidines / Q000627:therapeutic use*; D021681:Scedosporium / Q000302:isolation & purification*; D033581:Stem Cell Transplantation; D000077291:Terbinafine; D014230:Triazoles / Q000627:therapeutic use*; D065819:Voriconazole
chemical_list: D000935:Antifungal Agents; D009281:Naphthalenes; D011743:Pyrimidines; D014230:Triazoles; D000077291:Terbinafine; D065819:Voriconazole