Reactions 1388 - 11 Feb 2012

SAntineoplastics/corticosteroids

Disseminated fusariosis treated withvoriconazole: case report

A 53-year-old woman developed disseminated fusariosisduring treatment with antineoplastics and corticosteroids[routes and dosages not stated for all drugs; durations oftreatments to reaction onset not clearly stated] for acutelymphoblastic leukaemia. She was treated withvoriconazole.

The woman received a combined chemotherapy regimen(hyper-CVAD) with imatinib. Her induction chemotherapycomprised cyclophosphamide 300 mg/m2 for 3 days,vincristine 2 mg/day on days 4 and 11, doxorubicin50 mg/m2 on day 4, and oral imatinib 800 mg/day was givenon days 1 to 15. From day 11 to day 14, she receiveddexamethasone 40 mg/day. On days 1, 8, and 15,cytarabine, methotrexate, and hydrocortisone wereadministered. Subsequently, she developed a fever.

The woman was treated with an antibiotic and shebecame apyrexic the next day. However, on day 4, shedeveloped profound neutropenia. She receivedpegfilgrastim on day 6. She presented with diarrhoea onday 8 and received symptomatic therapy. A toe whitlowwas presented on day 9 and she developed neutropenicfever on day 16, with myalgia, shiver, and cutaneouseruptions. A fungal infection was suspected and her anti-infective drugs were changed. Tests showed elevatedgalactomannan levels and a CT scan revealed non-specificlung lesions. Her skin lesions spread over her body and shestarted treatment with oral voriconazole on day 19. Thedose was 400mg twice daily for the first day, and thereafter200mg twice daily. Tests on her skin lesions andbronchoalveolar lavage revealed Fusarium solani. Afterstarting voriconazole, her symptoms progressivelyimproved. She developed minor hepatic dysfunction withvoriconazole but treatment continued during her secondintensive consolidation chemotherapy regimen [drugs notspecified]. She had no reactivation of fusariosis. Her skinlesions completely resolved and tests confirmed completeremission. At last follow-up, she was waiting for anallograft.Labois A, et al. Successful treatment of disseminated fusariosis with voriconazolein an acute lymphoblastic leukaemia patient. Mycoses 54 (Suppl. 4): 8-11, No. 4,Dec 2011. Available from: URL: http://dx.doi.org/10.1111/j.1439-0507.2011.02136.x - France 803066839

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Reactions 11 Feb 2012 No. 13880114-9954/10/1388-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved