Fatal fungemia with Scedosporium prolificans in a patient with acute myeloid leukemia.
Scedosporium prolificans (S. prolificans) is a type of mold, which rarely affects immunocompromised people. We treated a 71-year-old woman with acute myeloid leukemia (AML-M5a) with low-dose cytarabine, acralubicin, and filgrastim as the induction therapy. On day 7 after the initiation of chemotherapy, she became febrile and agranulocytic, and developed anal pain ; therefore, we discontinued the chemotherapy on day 8. Broad-spectrum antibiotics, micafungin, and then liposomal amphotericin B were ineffective. The serum concentration of β-D-glucan was 525 pg/mL. She died of multiple organ failure on day 17. S. prolificans was detected from the blood culture on day 13. Physicians should consider Scedosporium spp. infection when principal antifungal agents are ineffective and fungal infection is strongly suspected.
Departments of Hematology Shinko Hospital, Kobe.
Makoto
M
Nishimori
Toshio
T
Takahashi
Eiko
E
Suzuki
Taiichi
T
Kodaka
Nobuhiro
N
Hiramoto
Kiminari
K
Itoh
Hiroko
H
Tsunemine
Kyoko
K
Yarita
Katsuhiko
K
Kamei
Hiroshi
H
Takegawa
Takayuki
T
Takahashi
D000368:Aged; D000666:Amphotericin B / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use; D015415:Biomarkers / Q000097:blood; D054714:Echinocandins / Q000627:therapeutic use; D017809:Fatal Outcome; D005260:Female; D016469:Fungemia / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology* / Q000382:microbiology*; D006801:Humans; D016867:Immunocompromised Host; D015470:Leukemia, Myeloid, Acute / Q000150:complications* / Q000188:drug therapy; D055666:Lipopeptides / Q000627:therapeutic use; D000077551:Micafungin; D009102:Multiple Organ Failure / Q000209:etiology; D021681:Scedosporium / Q000302:isolation & purification*; D017211:Treatment Failure; D047071:beta-Glucans / Q000097:blood
D015415:Biomarkers; D054714:Echinocandins; D055666:Lipopeptides; D047071:beta-Glucans; D000666:Amphotericin B; D000077551:Micafungin