Breakthrough zygomycosis on posaconazole prophylaxis after allogeneic stem cell transplantation.
Antifungal prophylaxis with posaconazole (POS) has been shown to decrease the mortality associated with invasive fungal infections in high-risk patients. We report on a patient, with severe graft-versus-host disease after allogeneic stem cell transplantation, who developed proven pneumonia due to Rhizopus microsporus after 40 days of POS prophylaxis (fasting serum levels: 691-904 ng/mL). Despite combination treatment with liposomal amphotericin B and POS for 39 days, the patient died from pulmonary hemorrhage. This case highlights the need for continued awareness of breakthrough zygomycosis in patients receiving POS.
Mousset
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Medizinische Klinik II, Klinikum der J.W. Goethe-Universität, Frankfurt am Main, Germany. sabine.mousset@kgu.de
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Heinz
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Tintelnot
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Rickerts
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D000666:Amphotericin B / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use*; D018890:Chemoprevention; D004359:Drug Therapy, Combination; D017809:Fatal Outcome; D006086:Graft vs Host Disease / Q000209:etiology; D006801:Humans; D008172:Lung Diseases, Fungal / Q000188:drug therapy / Q000382:microbiology / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009091:Mucormycosis / Q000382:microbiology / Q000473:pathology / Q000517:prevention & control*; D011014:Pneumonia / Q000188:drug therapy / Q000382:microbiology / Q000473:pathology*; D012233:Rhizopus / Q000145:classification / Q000187:drug effects / Q000302:isolation & purification*; D033581:Stem Cell Transplantation / Q000009:adverse effects*; D014184:Transplantation, Homologous / Q000009:adverse effects*; D014230:Triazoles / Q000627:therapeutic use*
D000935:Antifungal Agents; D014230:Triazoles; C068538:liposomal amphotericin B; C101425:posaconazole; D000666:Amphotericin B