title: [Fatal zygomycosis caused by Mucor indicus after haplo-identical stem cell transplantation].
abstract: A 62-year-old woman with acute lymphoblastic leukemia in first complete remission was treated with unrelated cord blood transplantation, but exhibited primary graft failure. She then underwent HLA-haploidentical peripheral blood stem cell transplantation from her daughter. The conditioning regimen consisted of fludarabine 30 mg/m(2)/day for 6 days, intravenous busulfan 3.2 mg/kg/day for 2 days, and thymoglobulin 1 mg/kg/day for 2 days. Voriconazole was administered to prevent fungal infections. The patient achieved prompt hematopoietic recovery. Fever was observed 21 days after the second transplant, followed by sigmoid colon perforation and a liver space occupying lesion (SOL). A filamentous fungus was detected in a percutaneous biopsy of the liver SOL. In spite of changing the antifungal drug from voriconazole to liposomal amphotericin B, the patient died on day 41. The fungus was identified as Mucor indicus, a type of zygomycete. Although Mucor indicus inhabits soil, an infectious disease is extremely rare, and breakthrough infection after voriconazole prophylaxis had not been reported until now. It is mandatory to consider preventive antifungal treatment for drug-resistant fungal infectious diseases in patients after neutrophilic recovery with a strongly immunocompromised state after a HLA-haploidentical transplant.
authors.affiliation: Department of Medicine, Kurume University School of Medicine, Japan.
authors.forename: Satoko
authors.initials: S
authors.lastname: Koteda
authors.forename: Kei
authors.initials: K
authors.lastname: Nomura
authors.forename: Michitoshi
authors.initials: M
authors.lastname: Hashiguchi
authors.forename: Kuniki
authors.initials: K
authors.lastname: Kawaguchi
authors.forename: Eijiro
authors.initials: E
authors.lastname: Oku
authors.forename: Koichi
authors.initials: K
authors.lastname: Osaki
authors.forename: Takayuki
authors.initials: T
authors.lastname: Nakamura
authors.forename: Fumihiko
authors.initials: F
authors.lastname: Mouri
authors.forename: Rie
authors.initials: R
authors.lastname: Imamura
authors.forename: Ritsuko
authors.initials: R
authors.lastname: Seki
authors.forename: Koji
authors.initials: K
authors.lastname: Nagafuji
authors.forename: Koichi
authors.initials: K
authors.lastname: Makimura
authors.forename: Takashi
authors.initials: T
authors.lastname: Okamura
mesh_terms: D005260:Female; D006086:Graft vs Host Disease / Q000188:drug therapy*; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D008875:Middle Aged; D009089:Mucor / Q000302:isolation & purification*; D016896:Treatment Outcome; D014740:Vidarabine / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000627:therapeutic use; D020096:Zygomycosis / Q000188:drug therapy* / Q000209:etiology
chemical_list: D014740:Vidarabine; C024352:fludarabine