title: Disseminated Rhizopus microsporus infection cured by salvage allogeneic hematopoietic stem cell transplantation, antifungal combination therapy, and surgical resection.
abstract: Invasive Zygomycetes infection complicating prolonged neutropenia is associated with high mortality in the absence of immune recovery. We report a patient who developed disseminated zygomycosis due to Rhizopus microsporus during induction chemotherapy for acute myeloid leukemia. Rescue allogeneic hematopoietic stem cell transplantation (allo-HSCT) was performed as her only chance of cure of this infection and to treat refractory leukemia. Posaconazole combined with liposomal amphotericin B contained the zygomycosis during prolonged neutropenia due to allo-HSCT followed by intense immunosuppression for grade IV acute graft-versus-host disease. Surgical removal of all infected sites after immune recovery, with prolonged posaconazole treatment, ultimately cured the infection. New combination antifungal therapies might sufficiently control disseminated zygomycosis to allow allo-HSCT to be performed, assuring life-saving immune recovery. Surgery appears to be necessary for definite cure of these infections.
authors.affiliation: Department of Medicine, Hematology Division, University Hospital Geneva, Geneva, Switzerland. oliver.lebeau@ne.ch
authors.forename: O
authors.initials: O
authors.lastname: Lebeau
authors.forename: C
authors.initials: C
authors.lastname: Van Delden
authors.forename: J
authors.initials: J
authors.lastname: Garbino
authors.forename: J
authors.initials: J
authors.lastname: Robert
authors.forename: F
authors.initials: F
authors.lastname: Lamoth
authors.forename: J
authors.initials: J
authors.lastname: Passweg
authors.forename: Y
authors.initials: Y
authors.lastname: Chalandon
mesh_terms: D000666:Amphotericin B / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000150:complications / Q000188:drug therapy; D008875:Middle Aged; D009091:Mucormycosis / Q000188:drug therapy* / Q000276:immunology / Q000382:microbiology / Q000601:surgery*; D012233:Rhizopus / Q000145:classification / Q000187:drug effects* / Q000302:isolation & purification; D016879:Salvage Therapy; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D014230:Triazoles / Q000627:therapeutic use
chemical_list: D000935:Antifungal Agents; D014230:Triazoles; C068538:liposomal amphotericin B; C101425:posaconazole; D000666:Amphotericin B