title: Successful treatment of Scedosporium apiospermum soft tissue abscess with caspofungin and voriconazole in a severely immunocompromised patient with acute myeloid leukemia.
abstract: We report the case of a 53-year-old female patient with refractory acute myeloid leukemia developing a necrotic, soft tissue abscess on the right forearm caused by Scedosporium apiospermum during prolonged severe neutropenia (absolute white blood cell count <500/μL for 49 days). In the context of the severely immunocompromised state of the patient and her need for allogeneic hematopoietic stem cell transplantation (HSCT), surgical treatment options were not favored. Therefore, combined antifungal therapy with voriconazole and caspofungin was started, based on the results of the in vitro testing (minimum inhibitory concentrations of voriconazole, posaconazole, and amphotericin B: 1, 4, and >2mg/L, respectively). The local site of infection slowly improved clinically and no spread of S. apiospermum infection to other sites was observed. After HSCT, the soft tissue abscess resolved completely and the patient has remained free of S. apiospermum infection since then. We successfully demonstrate that the use of combined antifungal therapy with voriconazole and casopfungin may further improve the clinical course and provides a promising therapeutic option to treat Scedosporium infections in such patients.
authors.affiliation: Department of Hematology and Oncology, University of Regensburg, Regensburg, Germany.
authors.forename: F
authors.initials: F
authors.lastname: Beier
authors.forename: N
authors.initials: N
authors.lastname: Kittan
authors.forename: T
authors.initials: T
authors.lastname: Holzmann
authors.forename: K
authors.initials: K
authors.lastname: Schardt
authors.forename: R
authors.initials: R
authors.lastname: Andreesen
authors.forename: E
authors.initials: E
authors.lastname: Holler
authors.forename: G C
authors.initials: GC
authors.lastname: Hildebrandt
mesh_terms: D000038:Abscess / Q000382:microbiology* / Q000473:pathology; D000935:Antifungal Agents / Q000627:therapeutic use*; D000077336:Caspofungin; D054714:Echinocandins / Q000627:therapeutic use*; D005260:Female; D005542:Forearm / Q000473:pathology; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D016867:Immunocompromised Host; D015470:Leukemia, Myeloid, Acute / Q000628:therapy; D055666:Lipopeptides; D008875:Middle Aged; D008271:Mycetoma / Q000188:drug therapy* / Q000382:microbiology / Q000473:pathology; D011743:Pyrimidines / Q000627:therapeutic use*; D021681:Scedosporium / Q000145:classification / Q000187:drug effects* / Q000302:isolation & purification; D018461:Soft Tissue Infections / Q000188:drug therapy* / Q000382:microbiology / Q000473:pathology; D016896:Treatment Outcome; D014230:Triazoles / Q000627:therapeutic use*; D065819:Voriconazole
chemical_list: D000935:Antifungal Agents; D054714:Echinocandins; D055666:Lipopeptides; D011743:Pyrimidines; D014230:Triazoles; D000077336:Caspofungin; D065819:Voriconazole