title: [Multiple myeloma complicated with disseminated zygomycosis after bortezomib therapy].
abstract: A 67-year-old man was diagnosed with multiple myeloma IgA-lambda type, Durie-Salmon classification stage IIIA in October 2001. He received five courses of induction chemotherapy consisting of vincristine, doxorubicin and dexamethasone and then underwent high dose chemotherapy followed by autologous stem cell transplantation in March 2003. He achieved partial response, but then relapsed after treatment with thalidomide and was admitted to our hospital in June 2007. The patient was complicated by tumor lysis syndrome (TLS) after receiving bortezomib therapy twice. Computed tomography after bortezomib therapy showed the rapid appearance of tumors in the right upper lobe of the lung, tail of the pancreas and the spleen. Though he was treated with antifungal agents, micafungin and voriconazole, he died eighty-five days after admission. Autopsy specimen showed fungal clumps and hemorrhagic infarction in the lung and spleen, and vegetation at the mitral valve was the same fungus as found in the lung. We diagnosed disseminated zygomycosis based on the pathological fungal morphology. This case suggested that metabolic acidosis was caused by TLS, while poorly controlled diabetes, secondary hemochromatosis due to transfusion, and breakthrough zygomycosis during antifungal therapy were thought to be factors contributing to the development of zygomycosis.
authors.affiliation: Department of Medicine and Bioregulatory Sciences, University of Tokushima Graduate School of Medicine.
authors.forename: Shingen
authors.initials: S
authors.lastname: Nakamura
authors.forename: Kenichiro
authors.initials: K
authors.lastname: Yata
authors.forename: Tadashi
authors.initials: T
authors.lastname: Jinno
authors.forename: Takeshi
authors.initials: T
authors.lastname: Harada
authors.forename: Shiro
authors.initials: S
authors.lastname: Fujii
authors.forename: Hirokazu
authors.initials: H
authors.lastname: Miki
authors.forename: Ayako
authors.initials: A
authors.lastname: Nakano
authors.forename: Kumiko
authors.initials: K
authors.lastname: Kagawa
authors.forename: Kyoko
authors.initials: K
authors.lastname: Takeuchi
authors.forename: Shuji
authors.initials: S
authors.lastname: Ozaki
authors.forename: Masahiro
authors.initials: M
authors.lastname: Abe
authors.forename: Toshio
authors.initials: T
authors.lastname: Matsumoto
mesh_terms: D000138:Acidosis / Q000209:etiology; D000368:Aged; D000935:Antifungal Agents / Q000009:adverse effects / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use*; D001897:Boronic Acids / Q000009:adverse effects* / Q000627:therapeutic use*; D000069286:Bortezomib; D054714:Echinocandins / Q000009:adverse effects / Q000627:therapeutic use; D017809:Fatal Outcome; D006801:Humans; D055666:Lipopeptides / Q000009:adverse effects / Q000627:therapeutic use; D008297:Male; D000077551:Micafungin; D009101:Multiple Myeloma / Q000150:complications* / Q000188:drug therapy*; D011719:Pyrazines / Q000009:adverse effects* / Q000627:therapeutic use*; D011743:Pyrimidines / Q000009:adverse effects / Q000627:therapeutic use; D014230:Triazoles / Q000009:adverse effects / Q000627:therapeutic use; D015275:Tumor Lysis Syndrome / Q000209:etiology; D065819:Voriconazole; D020096:Zygomycosis / Q000188:drug therapy / Q000209:etiology* / Q000473:pathology*
chemical_list: D000935:Antifungal Agents; D000970:Antineoplastic Agents; D001897:Boronic Acids; D054714:Echinocandins; D055666:Lipopeptides; D011719:Pyrazines; D011743:Pyrimidines; D014230:Triazoles; D000069286:Bortezomib; D065819:Voriconazole; D000077551:Micafungin