Treatment of intestinal and hepatic mucormycosis in an immunocompromized child.
During ALL chemotherapy, a 4-year-old patient presented with febrile neutropenia and abdominal pain. Ultrasound examinations were repeatedly normal. Computerized tomography on day 7 demonstrated appendicitis and multiple hepatic foci identified as mucormycosis (Absidia corymbifera). Successful outcome was achieved by aggressive re-surgery, long-term antifungal therapy with serum level-monitored posaconazole, and recovery of neutrophil counts. Considering the interference of posaconazole with CYP3A4, vincristine was administered during 72 hr posaconazole windows. Pediatric intestinal mucormycosis, still associated with a >70% case-fatality rate, calls for early imaging and surgery to establish the diagnosis, reduce the fungal mass, and provide a rationale for using posaconazole.
Lüer
Sonja
S
Division of Pediatric Hematology, Department of Pediatrics, University of Bern, Bern, Switzerland.
Berger
Steffen
S
Diepold
Miriam
M
Duppenthaler
Andrea
A
von Gunten
Michael
M
Mühlethaler
Konrad
K
Wolf
Rainer
R
Aebi
Christoph
C
D000935:Antifungal Agents / Q000627:therapeutic use; D000972:Antineoplastic Agents, Phytogenic / Q000627:therapeutic use; D002675:Child, Preschool; D004359:Drug Therapy, Combination; D006801:Humans; D016867:Immunocompromised Host; D007410:Intestinal Diseases / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000382:microbiology; D008107:Liver Diseases / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000382:microbiology; D008279:Magnetic Resonance Imaging; D008297:Male; D009091:Mucormycosis / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000382:microbiology; D015452:Precursor B-Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy* / Q000276:immunology; D014057:Tomography, X-Ray Computed; D014230:Triazoles / Q000627:therapeutic use; D014750:Vincristine / Q000627:therapeutic use
D000935:Antifungal Agents; D000972:Antineoplastic Agents, Phytogenic; D014230:Triazoles; D014750:Vincristine; C101425:posaconazole