title: Successful treatment of Aspergillus liver abscesses in a patient with acute monoblastic leukemia using combination antifungal therapy including micafungin as a key drug.
abstract: While anti-cancer chemotherapy has improved the survival of patients with hematologic malignancies, it has also exposed such patients to the risk of life-threatening infection due to neutropenia. In intensive chemotherapy for leukemia, invasive aspergillosis resulting in death is infrequently observed. In such cases, aggressive diagnostic and therapeutic intervention is required. Herein, we report a case of Aspergillus liver abscesses in a patient with acute monoblastic leukemia. The patient presented with febrile neutropenia and concomitantly with an elevated serum beta-D: -glucan level during chemotherapy. The abscesses were finally diagnosed by liver biopsy. Although antifungal monotherapy of voriconazole or liposomal amphotericin B, both of which are recommended for invasive aspergillosis, showed a poor response, when combined with micafungin, an echinocandin, both had a highly favorable effect against the infection. Therefore, our clinical experience suggests that the serum test is useful for the rapid diagnosis of invasive aspergillosis, especially in deep tissues, and that combination antifungal therapy with micafungin should be considered when initial monotherapy for fungal infection shows an insufficient effect.
authors.affiliation: Department of Hematology and Infectious Diseases, Kumamoto University Graduate School of Medical Sciences, Kumamoto, Japan.
authors.forename: Rie
authors.initials: R
authors.lastname: Yamada
authors.forename: Kentaro
authors.initials: K
authors.lastname: Horikawa
authors.forename: Sonoko
authors.initials: S
authors.lastname: Ishihara
authors.forename: Koyu
authors.initials: K
authors.lastname: Hoshino
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Kawaguchi
authors.forename: Ken-ichi
authors.initials: K
authors.lastname: Iyama
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Mitsuya
authors.forename: Norio
authors.initials: N
authors.lastname: Asou
mesh_terms: D000935:Antifungal Agents / Q000008:administration & dosage*; D001228:Aspergillosis / Q000150:complications / Q000188:drug therapy*; D004359:Drug Therapy, Combination; D054714:Echinocandins / Q000008:administration & dosage*; D006505:Hepatitis / Q000150:complications / Q000188:drug therapy* / Q000382:microbiology; D006801:Humans; D007948:Leukemia, Monocytic, Acute / Q000150:complications*; D055666:Lipopeptides / Q000008:administration & dosage*; D008100:Liver Abscess / Q000150:complications / Q000188:drug therapy* / Q000382:microbiology; D008297:Male; D000077551:Micafungin; D008875:Middle Aged
chemical_list: D000935:Antifungal Agents; D054714:Echinocandins; D055666:Lipopeptides; D000077551:Micafungin