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Disseminated fusariosis and other toxicities: case report A 61-year-old woman developed cytomegalovirus (CMV) infection, neutropenia, hypogammaglobulinaemia and disseminated fusariosis during immunosuppressive treatment with ciclosporin, mycophenolate and prednisone. Additionally, the empirical treatment with caspofungin for fever contributed to fusariosis [routes, dosages and times to reactions onsets not stated; not all outcomes stated]. The woman, who had cryptogenic liver failure, had undergone an ABO-incompatible orthotopic liver transplantation (OLT) in June 2003 at a hospital in Italy. Her immunosuppressive therapy included ciclosporin [cyclosporine], mycophenolate and prednisone. After 25 days, she was discharged from the hospital, without any major surgical complications. Forty-five days following the OLT, she was diagnosed with CMV infection with fever at another hospital. The woman was treated with ganciclovir, leading to the resolution of fever and negative results of CMV antigenaemia. Fifty-five days following the OLT, she again developed fever and severe leucopenia with neutropenia. Therefore, she was moved to a hospital in Italy. She was noted to have a profound hypogammaglobulinaemia, and multiple pulmonary small nodules were noted on a chest CT scan. Enterococcus faecium was isolated from the biliary catheter. She started receiving empirical treatment with caspofungin, teicoplanin and meropenem for fever. Then, she was moved to another unit of hospital to characterise the pulmonary lesions at day 70 after the OLT. After 2 days, blood cultures were found positive for fungal hyphae, and the culture was identified to be positive for a Fusarium spp. It was noted that the treatment with potent immunosuppressive therapy caused CMV infection, neutropenia and hypogammaglobulinemia, which further led to fusariosis. Additionally, the empiric therapy with caspofungin contributed to disseminated fusariosis(breakthrough fusarium spp fungaemia). Therefore, therapy with ciclosporin, mycophenolate and prednisone was discontinued, and she was started on tacrolimus monotherapy. She was also treated with amphotericin-B-liposomal [liposomal amphotericin B], immune globulin [immunoglobulin] and unspecified granulocyte-colony stimulating factor, with resolution of the pulmonary lesions. Her therapy with amphotericin-B-liposomal and reduction of immunosuppressive therapy cured the fusariosis. After 1 month, she was again diagnosed with fever and pleural effusion, and the pleural fluid was negative for bacteria and fungi. Small lymphocytes were noted on cytological examination, and bone marrow biopsy revealed CD20 positive Bcell lymphoma [aetiologies not stated]. Therefore, she was treated with rituximab, leading to a complete resolution of the pleural effusion. However, after 9 months, she developed severe cachexia, and died due to a non-functioning liver. Autopsy was not performed. Tascini C, et al. Breakthrough fusarium spp fungemia during caspofungin therapy in an abo-incompatible orthotopic liver transplant pati