[Acute renal tubular damage caused by disseminated Trichosporon infection in primary myelofibrosis].
A 70-year-old man received a course of therapy that consisted of prednisolone, cyclosporine, and etoposide due to hemophagocytic syndrome which had developed during primary myelofibrosis. He also received micafungin (MCFG) as prophylaxis against a potential fungal infection. We diagnosed febrile neutropenia due to the hemophagocytic syndrome therapy and candidemia because Candida species were detected in blood cultures. He received liposomal amphotericin B (L-AMB) for the candidemia but did not respond to this treatment. Oliguria was diagnosed and renal failure progressed rapidly. We suspected that his renal failure had been induced by the antibiotics. We thus changed the antibiotic regimen but he died of progressive renal failure. We performed renal necropsy and diagnosed acute interstitial tubular nephritis, due to a yeast-like fungus that generally invades the renal tubules. The yeast-like fungus was later identified as Trichosporon asahii, rather than candida, by blood cultures. An immunocompromised host receiving MCFG for acute progressive renal failure requires an appropriate antifungal drug considering the possibility of disseminated Trichosporon.
Department of Hematology, Hakodate Municipal Hospital.
Joji
J
Shimono
Yutaka
Y
Tsutsumi
Hiroyuki
H
Ohigashi
D000208:Acute Disease; D000368:Aged; D000666:Amphotericin B / Q000627:therapeutic use; D054714:Echinocandins / Q000627:therapeutic use; D006801:Humans; D007684:Kidney Tubules / Q000293:injuries*; D055666:Lipopeptides / Q000627:therapeutic use; D008297:Male; D000077551:Micafungin; D009503:Neutropenia / Q000175:diagnosis / Q000628:therapy; D055728:Primary Myelofibrosis / Q000175:diagnosis / Q000382:microbiology / Q000628:therapy*; D014250:Trichosporon; D060586:Trichosporonosis / Q000150:complications*
D054714:Echinocandins; D055666:Lipopeptides; C068538:liposomal amphotericin B; D000666:Amphotericin B; D000077551:Micafungin