title: Salvage Treatment of Mucormycosis Post-Liver Transplant With Posaconazole During Sirolimus Maintenance Immunosuppression.
abstract: We describe the first successful case of posaconazole salvage therapy for mucormycosis with concomitant sirolimus (SRL) maintenance immunosuppression following liver transplantation, despite black box drug interaction following intolerance to first-line tacrolimus and amphotericin due to nephrotoxicity and neurotoxicity. This case describes a 55-year-old female who developed rhinocerebral mucormycosis 108 days after liver transplantation. After 3 months of posaconazole therapy, the patient remains free of disease at 3 years posttransplant. This case report illustrates successful resolution of mucormycosis without SRL toxicity to resolve nephrotoxicity of long-term amphotericin on top of already nephrotoxic immunosuppression. With higher bioavailability of recently FDA-approved posaconazole delayed release tablets, this azole may be a therapeutic option for transplant patients who need to remain on CYP3A4-metabolized immunosuppressive agents.
authors: 1 Department of Pharmacy, University of North Carolina, Memorial Hospital, Chapel Hill, NC, USA.
authors: Jennifer C
authors: JC
authors: Deyo
authors: 2 Department of Pharmacy, Vidant Medical Center, Greenville, NC, USA.
authors: Nicole
authors: N
authors: Nicolsen
authors: 3 Department of Medicine, School of Medicine, University of North Carolina, Chapel Hill, NC, USA.
authors: Anne
authors: A
authors: Lachiewicz
authors: 4 Department of Surgery, School of Medicine, University of North Carolina, Chapel Hill, NC, USA.
authors: Tomasz
authors: T
authors: Kozlowski
mesh_terms: D000935:Antifungal Agents / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D016031:Liver Transplantation / Q000009:adverse effects*; D060046:Maintenance Chemotherapy / Q000379:methods; D008875:Middle Aged; D009091:Mucormycosis / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D016879:Salvage Therapy / Q000379:methods*; D020123:Sirolimus / Q000008:administration & dosage*; D016896:Treatment Outcome; D014230:Triazoles / Q000008:administration & dosage*
chemical_list: D000935:Antifungal Agents; D007166:Immunosuppressive Agents; D014230:Triazoles; C101425:posaconazole; D020123:Sirolimus
keywords: immunosuppression; liver transplantation; mucormycosis; zygomycosis