• PDF / 175,480 Bytes
• 1 Pages / 595.245 x 841.846 pts (A4) Page_size
• 6 Downloads / 154 Views

DOWNLOAD

REPORT

---

1 S

Lack of efficacy and toxic epidermal necrolysis: 2 case reports In a case series, a 13-year-old girl and a 7-year-old boy were described, who exhibited lack of efficacy during treatment with amphotericin-b-liposomal and posaconazole or developed toxic epidermal necrolysis during treatment with amphotericin-bliposomal for mucormycosis [not all routes and dosages stated]. Case 2: The 13-year-old girl was diagnosed with high risk B cell Philadelphia chromosome-positive acute lymphoblastic leukaemia in 2017 and started receiving chemotherapy as per AIEOP-BFM 2009 protocol. On day 20 of induction chemotherapy while on prednisone, she was admitted to the ICU due to septic shock and febrile neutropenia. She was diagnosed with Pseudomonas sp. bacteremia and severe pneumonia, with pleural effusion due to Pseudomonas sp. and Aspergillus sp. Hence, she received treatment with ciprofloxacin, meropenem and voriconazole that led to resolution of neutropenia on day 10 of admission. But, she had fever and increased inflammatory marker that required haemodynamic and respiratory support. On admission day 15, her abdominal CT scan showed a 2.5cm lesion in the liver. Hence, treatment with amphotericin-b-liposomal [liposomal amphotericin B] 5 mg/kg followed by 10 mg/kg with posaconazole delayed-release tablets was started. Voriconazole was suspended. Repeat CT showed disseminated mucormycosis involving the colon, intestine, liver, spleen, left kidney and abdominal wall. Subsequently, she underwent two surgeries for removal of jejunum, descending colon, spleen, left kidney and left lobe of the liver along with extensive debridement of the abdominal wall. The Calcofluor fluorescence microscopy of resected specimen showed mucormycosis and the culture showed positive result for Lichtheimia corymbifera. Sequencing was compatible with culture results and identified Lichtheimia corymbifera. On day 33, she had no improvement despite 2 weeks treatment with amphotericin-bliposomal and posaconazole. She had fever, and remained hemodynamically unstable and critically ill. Therefore, off label salvage treatment with IV isavuconazole was started in addition to amphotericin-b-liposomal. At day 36, clinical improvement was noted. At day 40, a week after isavuconazole initiation, radiologic improvement was noted with resolution of lesions and residual thickening of the colon. On day 45, she was weaned from ventilation. Thereafter, she was treated with blinatumomab, imatinib and intrathecal chemotherapy. At day 73, complete resolution of the lesion was noted. Therefore, isavuconazole 200 mg/day (3.5 mg/kg/day) was continued as monotherapy till day 94 and then changed to posaconazole monotherapy for following 6 months. During the first two months of admission, she had received meropenem for Pseudomonas sp and vancomycin for coagulase-negative Staphylococcus central line associated bloodstream infection. On admission day 154, she was discharged to rehabilitation center, where she continued induction chemotherapy. At the follow-up visit, one year late