Fatal rhizopus pneumonia in allogeneic stem cell transplant patients despite posaconazole prophylaxis: two cases and review of the literature.
Posaconazole is a triazole with broad spectrum of activity against multiple fungi including members of the fungal order Mucorales. This activity has been shown both in clinical and in vitro studies, which are critically reviewed here. It has become very popular in prophylaxis in acute myelogenous leukemia (AML) induction and in the graft-versus-host disease (GVHD) settings after 2 recent prospective trials that showed advantage of posaconazole prophylaxis compared to fluconazole or itraconazole. In this report, 2 patients are presented, in whom, despite posaconazole prophylaxis, invasive and ultimately fatal Rhizopus pulmonary infections developed. These cases are similar to a previously reported case of Rhizopus infection in a stem cell transplant recipient who also received posaconazole, indicating a potential newly recognized pattern of breakthrough infections in patients receiving posaconazole prophylaxis.
Lekakis
Lazaros J
LJ
Markey Cancer Center, University of Kentucky, Lexington, Kentucky 40536, USA. ljleka2@uky.edu
Lawson
Amber
A
Prante
Jeanette
J
Ribes
Julie
J
Davis
Gregory J
GJ
Monohan
Gregory
G
Baraboutis
Ioannis G
IG
Skoutelis
Athanasios T
AT
Howard
Dianna S
DS
D000935:Antifungal Agents / Q000627:therapeutic use; D018890:Chemoprevention / Q000379:methods; D017809:Fatal Outcome; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009091:Mucormycosis / Q000209:etiology; D011014:Pneumonia / Q000209:etiology* / Q000382:microbiology; D012233:Rhizopus; D014184:Transplantation, Homologous; D014230:Triazoles / Q000627:therapeutic use*
D000935:Antifungal Agents; D014230:Triazoles; C101425:posaconazole