Antineoplastics
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Reactions 1289 - 20 Feb 2010 S Antineoplastics Neutropenia leading to fatal Geotrichum candidum infection?: case report A 56-year-old woman receiving antineoplastics for acute myeloid leukaemia (AML) developed neutropenia, which lead to infection with Geotrichum candidum; she subsequently died. The woman had undergone a stem cell transplant and subsequently developed graft-versus-host disease, veno- occlusive disorder and renal impairment. One year posttransplantation, her AML relapsed and she was hospitalised for re-induction chemotherapy. At that time, she was receiving prednisone 20mg daily [duration of therapy not stated], with aciclovir, atovaquone and nystatin. Her WBC count on admission was 21 320 cells/µL (neutrophils 38%). She was commenced on cytarabine and daunorubicin [dosages not stated]. On hospital day 3, she developed a fever, and was administered antibacterials. Six days later, haemodialysis was started for acute renal failure, by which time her WBC count was 850 cells/µL (neutrophils 18%). The next day, a catheter was placed in her left internal jugular vein. Later that day, she became unresponsive, and over the next few days, her mental status waxed and waned. On day 13, increased diffuse bilateral opacities were seen on chest x-ray, due partly to pleural effusions. A week later, she developed hypotension and was administered dexamethasone [dosage not stated], cardiotonics, micafungin and metronidazole. Blood cultures revealed hyphal elements. After erythema and eschar were noted near the catheter entry site, the right- side catheter was removed. On day 22, micafungin was switched to voriconazole, as an invasive fungal infection was indicated. The left-side catheter was removed. At this time, her WBC count was 210 cells/µL with 32% neutrophils. A biopsy of skin adjacent to the catheter site revealed septal hyaline hyphae in the dermis, subcutaneous tissue and blood vessels. Her lungs demonstrated nodular opacities on CT scanning, and an MRI indicated protein-like material in the CSF. After she developed multiple organ failure, supportive care only was given, and the woman died on day 33. The Geotrichum species was positively identified from blood, sputum and skin biopsy specimens. Author comment: "Although rarely isolated, G. candidum can cause aggressive, disseminated disease and high mortality, it is important to include this organism in the differential diagnosis in immunocompromised patients with disseminated fungal infection." Henrich TJ, et al. Disseminated Geotrichum candidum infection in a patient with relapsed acute myelogenous leukemia following allogeneic stem cell transplantation and review of the literature. Transplant Infectious Disease 11: 458-62, No. 5, 1 Oct 2009 - USA 803006137 1 Reactions 20 Feb 2010 No. 1289 0114-9954/10/1289-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved
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Transcript of Antineoplastics
Reactions 1289 - 20 Feb 2010
SAntineoplastics
Neutropenia leading to fatal Geotrichumcandidum infection?: case report
A 56-year-old woman receiving antineoplastics for acutemyeloid leukaemia (AML) developed neutropenia, whichlead to infection with Geotrichum candidum; shesubsequently died.
The woman had undergone a stem cell transplant andsubsequently developed graft-versus-host disease, veno-occlusive disorder and renal impairment. One yearposttransplantation, her AML relapsed and she washospitalised for re-induction chemotherapy. At that time,she was receiving prednisone 20mg daily [duration oftherapy not stated], with aciclovir, atovaquone andnystatin. Her WBC count on admission was 21 320 cells/µL(neutrophils 38%). She was commenced on cytarabine anddaunorubicin [dosages not stated]. On hospital day 3, shedeveloped a fever, and was administered antibacterials. Sixdays later, haemodialysis was started for acute renal failure,by which time her WBC count was 850 cells/µL(neutrophils 18%). The next day, a catheter was placed inher left internal jugular vein. Later that day, she becameunresponsive, and over the next few days, her mentalstatus waxed and waned. On day 13, increased diffusebilateral opacities were seen on chest x-ray, due partly topleural effusions. A week later, she developed hypotensionand was administered dexamethasone [dosage not stated],cardiotonics, micafungin and metronidazole. Bloodcultures revealed hyphal elements. After erythema andeschar were noted near the catheter entry site, the right-side catheter was removed. On day 22, micafungin wasswitched to voriconazole, as an invasive fungal infectionwas indicated. The left-side catheter was removed. At thistime, her WBC count was 210 cells/µL with 32%neutrophils. A biopsy of skin adjacent to the catheter siterevealed septal hyaline hyphae in the dermis, subcutaneoustissue and blood vessels. Her lungs demonstrated nodularopacities on CT scanning, and an MRI indicated protein-likematerial in the CSF.
After she developed multiple organ failure, supportivecare only was given, and the woman died on day 33. TheGeotrichum species was positively identified from blood,sputum and skin biopsy specimens.
Author comment: "Although rarely isolated, G. candidumcan cause aggressive, disseminated disease and highmortality, it is important to include this organism in thedifferential diagnosis in immunocompromised patients withdisseminated fungal infection."Henrich TJ, et al. Disseminated Geotrichum candidum infection in a patient withrelapsed acute myelogenous leukemia following allogeneic stem celltransplantation and review of the literature. Transplant Infectious Disease 11:458-62, No. 5, 1 Oct 2009 - USA 803006137
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Reactions 20 Feb 2010 No. 12890114-9954/10/1289-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved
