Antineoplastics
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Reactions 1365 - 20 Aug 2011 S Antineoplastics Scedosporium apiospermum skin infection: case report A 62-year-old woman developed a deep skin infection of Scedosporium apiospermum after receiving antineoplastics. The woman, who had refractory idiopathic thrombocytopenic purpura and B-cell lymphoma, received six cycles of rituximab, cyclophosphamide, doxorubicin, vincristine and prednisolone [dosages and routes not stated], followed by high-dose chemotherapy and autologous peripheral blood stem cell transplantation. A year later, idiopathic thrombocytopenic purpura relapsed and she received oral prednisolone 0.5 mg/kg daily, followed by four doses of rituximab 375 mg/m 2 weekly [route not stated] about 2 months later, without response. She received prednisolone 1 mg/m 2 [frequency and route not stated]. About 2 months after administration of rituximab, she developed erythema with pustules on the dorsal surface of her right first finger. She had injured the site slightly on a farm 4 months earlier. The lesion rapidly deteriorated. The woman received antibacterials, but developed deep ulceration. Laboratory investigations revealed the following: WBC count 3999/µL (neutrophils 72%, lymphocytes 19% and monocytes 9%), platelet count 1.0 x 10 4 /µL, AST 55 IU/L, ALT 158 IU/L, C-reactive protein 0.06 mg/dL and β-D-glucan titre 116 pg/mL. Mould was found in the lesion exudate, so she started receiving oral itraconazole. The lesion worsened with lymphangitic extension. Culture of the exudate identified S. apiospermum. She received oral voriconazole and underwent pus drainage twice daily. Decreased discharge was promptly noted. After 2 weeks, formation of regenerating epidermis was observed. Within 2 months, she had normal epidermis. Author comment: "The present case is considered as an immunocompromised patient because she had received high- dose steroid therapy . . . rituximab infusion . . . [and] chemotherapy and autologous [peripheral blood stem cell transplantation] . . . [this immunosuppression is thought to have] contributed to the development of deep skin infection and lymphangitic extension". Takeuchi M, et al. Deep skin infection of Scedosporium apiospermum in a patient with refractory idiopathic thrombocytopenic purpura. Internal Medicine 50: 1339-1343, No. 12, Jan 2011. Available from: URL: http://dx.doi.org/10.2169/ internalmedicine.50.4890 - Japan 803059006 1 Reactions 20 Aug 2011 No. 1365 0114-9954/10/1365-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved
Transcript of Antineoplastics
Reactions 1365 - 20 Aug 2011
SAntineoplastics
Scedosporium apiospermum skin infection: casereport
A 62-year-old woman developed a deep skin infection ofScedosporium apiospermum after receivingantineoplastics.
The woman, who had refractory idiopathicthrombocytopenic purpura and B-cell lymphoma, receivedsix cycles of rituximab, cyclophosphamide, doxorubicin,vincristine and prednisolone [dosages and routes notstated], followed by high-dose chemotherapy andautologous peripheral blood stem cell transplantation. Ayear later, idiopathic thrombocytopenic purpura relapsedand she received oral prednisolone 0.5 mg/kg daily,followed by four doses of rituximab 375 mg/m2 weekly[route not stated] about 2 months later, without response.She received prednisolone 1 mg/m2 [frequency and routenot stated]. About 2 months after administration ofrituximab, she developed erythema with pustules on thedorsal surface of her right first finger. She had injured thesite slightly on a farm 4 months earlier. The lesion rapidlydeteriorated.
The woman received antibacterials, but developed deepulceration. Laboratory investigations revealed thefollowing: WBC count 3999/µL (neutrophils 72%,lymphocytes 19% and monocytes 9%), platelet count1.0 x 104/µL, AST 55 IU/L, ALT 158 IU/L, C-reactive protein0.06 mg/dL and β-D-glucan titre 116 pg/mL. Mould wasfound in the lesion exudate, so she started receiving oralitraconazole. The lesion worsened with lymphangiticextension. Culture of the exudate identified S.apiospermum. She received oral voriconazole andunderwent pus drainage twice daily. Decreased dischargewas promptly noted. After 2 weeks, formation ofregenerating epidermis was observed. Within 2 months,she had normal epidermis.
Author comment: "The present case is considered as animmunocompromised patient because she had received high-dose steroid therapy . . . rituximab infusion . . . [and]chemotherapy and autologous [peripheral blood stem celltransplantation] . . . [this immunosuppression is thought tohave] contributed to the development of deep skin infectionand lymphangitic extension".Takeuchi M, et al. Deep skin infection of Scedosporium apiospermum in a patientwith refractory idiopathic thrombocytopenic purpura. Internal Medicine 50:1339-1343, No. 12, Jan 2011. Available from: URL: http://dx.doi.org/10.2169/internalmedicine.50.4890 - Japan 803059006
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Reactions 20 Aug 2011 No. 13650114-9954/10/1365-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved
