Posaconazole
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Lack of efficacy in aspergillosis prevention: case report A 19-year-old man with acute myeloid leukaemia developed aspergillosis despite prophylactic treatment with posaconazole [duration of treatment to reaction onset not stated]. The man was admitted 33 days after allogeneic haematopoietic stem cell transplant (HSCT) with acute graft-versus-host disease and cytomegalovirus reactivation. While in hospital, his antifungal therapy was switched from fluconazole to posaconazole three times daily 200 mg/day oral suspension with Coca-Cola. On day 76 post-HSCT he had a dry cough, pleuritic chest pain, mild dyspnoea and haemoptysis. A rapidly progressive pulmonary infiltrate was discovered by chest x-ray and CT scan. The man started receiving meropenem. Two days later, bronchoalveolar lavage was positive for galactomannan and septated hyphae, and Aspergillus fumigatus and Pseudomonas aeruginosa were identified by culture. No hyphae were noted in his pleural fluid, but a galactomannan test was positive, and cultures grew A. fumigatus; probable invasive pulmonary aspergillosis was diagnosed. His posaconazole serum concentration was found to be low, at 293 ng/mL and therapy was switched to voriconazole. His condition worsened and he received mechanical ventilation in an ICU. His infection was confirmed as angio-invasive pulmonary aspergillosis by open lung biopsy and culture 16 days later. After 4 weeks he was discharged from the ICU; his aspergillosis subsequently resolved. Author comment: "[P]osaconazole prophylaxis failed in the case described, possibly because of a concentration-effect relationship (despite administration with coca-cola to help increase absorption)." Maertens J, et al. Case report 1: A case of failed posaconazole prophylaxis. Mycoses 53 (Suppl. 2): 3-5, Jul 2010. Available from: URL: http:// 803028322 dx.doi.org/10.1111/j.1439-0507.2010.01906.x - Belgium
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Reactions 7 Aug 2010 No. 1313
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