Acanthamoeba infection in a patient with chronic graft-versus-host disease occurring during treatment with voriconazole.
We report a case of disseminated infection with Acanthamoeba in a patient with graft-versus-host disease after hematopoietic stem cell transplant (HSCT) for acute lymphocytic leukemia. The infection involved the brain, skin, and lungs and occurred despite treatment with voriconazole for mold prophylaxis, and did not respond to treatment with multiple other agents reported to have activity against Acanthamoeba. To our knowledge, infection with Acanthamoeba has been reported in 4 other patients after HSCT or bone marrow transplant, and our case is the first to be diagnosed ante-mortem.
Kaul
D R
DR
Department of Internal Medicine, Division of Infectious Diseases and University of Michigan Medical School, Ann Arbor, Michigan 48109-5378, USA. kauld@umich.edu
Lowe
L
L
Visvesvara
G S
GS
Farmen
S
S
Khaled
Y A
YA
Yanik
G A
GA
D000048:Acanthamoeba / Q000302:isolation & purification*; D000562:Amebiasis / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology / Q000473:pathology; D000818:Animals; D000935:Antifungal Agents / Q000008:administration & dosage / Q000009:adverse effects*; D000981:Antiprotozoal Agents / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D004660:Encephalitis / Q000175:diagnosis* / Q000188:drug therapy / Q000469:parasitology / Q000473:pathology; D017809:Fatal Outcome; D006086:Graft vs Host Disease / Q000517:prevention & control*; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D008168:Lung / Q000469:parasitology / Q000473:pathology; D008297:Male; D008875:Middle Aged; D010767:Phosphorylcholine / Q000031:analogs & derivatives / Q000627:therapeutic use; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000601:surgery*; D011743:Pyrimidines / Q000008:administration & dosage / Q000009:adverse effects*; D012867:Skin / Q000469:parasitology / Q000473:pathology; D014230:Triazoles / Q000008:administration & dosage / Q000009:adverse effects*; D065819:Voriconazole
D000935:Antifungal Agents; D000981:Antiprotozoal Agents; D011743:Pyrimidines; D014230:Triazoles; D010767:Phosphorylcholine; C039128:miltefosine; D065819:Voriconazole