Antineoplastics
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Reactions 857 - 23 Jun 2001 S Antineoplastics Rhinocerebral mucormycosis: case report Rhinocerebral mucormycosis developed in a 28-year-old man during antineoplastic therapy for acute lymphoblastic leukaemia. The man began induction therapy with vincristine, daunorubicin, asparaginase, prednisone and intrathecal methotrexate [dosages not stated] according to the standard risk protocol of the German Multicentre ALL Study Group. After 1 week’s treatment, he developed right-sided facial pain and received paracetamol [acetaminophen]. However, the pain worsened, and he required treatment with opioids. Three days later, the pain was located in the right fronto-orbital region and the vision of his right eye was blurred. On day 13 of therapy, the man developed fever and worsening headache. He began empirical treatment with imipenem and oral itraconazole. A CT scan of the orbitae and paranasal sinuses showed subtotal opacification of the right maxillary and ethmoidal sinuses, and an ear, nose and throat examination showed acute inflammation of the nasal mucous membranes. He was treated for acute sinusitis. 24 hours after starting antibacterial treatment, his fever resolved. However, the next day coagulase-negative staphylococci were identified in a blood sample. Two days later, his temperature rose again, his pain increased and his vision deteriorated further. Vancomycin and fluconazole were added to his treatment regimen. On day 20 of antineoplastic therapy, the man developed periorbital oedema and proptosis of his right eye, leading to necrosis of the lower lid. A biopsy from the mucosa of the right maxillary sinus showed broad nonseptate hyphal elements with right-angled branching, and he started amphotericin B and flucytosine on day 24. Antineoplastic therapy was stopped. He did not tolerate amphotericin B therapy and this agent was discontinued. A culture of the resected material identified Rhizopus arrhizus. On day 32, he underwent extensive surgical debridement. His fever and pain resolved. He received amphotericin B, but because of intolerance this was then replaced with liposomal amphotericin B [‘Ambisome’]. Also, weekly compresses soaked in amphotericin B were applied. Induction therapy was reinstated 3 weeks after surgery. The man stopped liposomal amphotericin B after a total of 40 days’ treatment, and started oral itraconazole. He then received consolidation therapy. Up until his death from disease progression approximately 8 months later, he did not experience any further signs or symptoms of recurrent mycotic infection. Lerchenm¨ uller C, et al. Rhinocerebral zygomycosis in a patient with acute lymphoblastic leukemia. Annals of Oncology 12: 415-419, Mar 2001 - Germany 800865363 1 Reactions 23 Jun 2001 No. 857 0114-9954/10/0857-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
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Transcript of Antineoplastics
Reactions 857 - 23 Jun 2001
SAntineoplastics
Rhinocerebral mucormycosis: case reportRhinocerebral mucormycosis developed in a 28-year-old
man during antineoplastic therapy for acute lymphoblasticleukaemia.
The man began induction therapy with vincristine,daunorubicin, asparaginase, prednisone and intrathecalmethotrexate [dosages not stated] according to the standardrisk protocol of the German Multicentre ALL Study Group.After 1 week’s treatment, he developed right-sided facial painand received paracetamol [acetaminophen]. However, thepain worsened, and he required treatment with opioids. Threedays later, the pain was located in the right fronto-orbitalregion and the vision of his right eye was blurred.
On day 13 of therapy, the man developed fever andworsening headache. He began empirical treatment withimipenem and oral itraconazole. A CT scan of the orbitae andparanasal sinuses showed subtotal opacification of the rightmaxillary and ethmoidal sinuses, and an ear, nose and throatexamination showed acute inflammation of the nasal mucousmembranes. He was treated for acute sinusitis. 24 hours afterstarting antibacterial treatment, his fever resolved. However,the next day coagulase-negative staphylococci were identifiedin a blood sample. Two days later, his temperature rose again,his pain increased and his vision deteriorated further.Vancomycin and fluconazole were added to his treatmentregimen.
On day 20 of antineoplastic therapy, the man developedperiorbital oedema and proptosis of his right eye, leading tonecrosis of the lower lid. A biopsy from the mucosa of the rightmaxillary sinus showed broad nonseptate hyphal elementswith right-angled branching, and he started amphotericin Band flucytosine on day 24. Antineoplastic therapy wasstopped. He did not tolerate amphotericin B therapy and thisagent was discontinued. A culture of the resected materialidentified Rhizopus arrhizus. On day 32, he underwentextensive surgical debridement. His fever and pain resolved.He received amphotericin B, but because of intolerance thiswas then replaced with liposomal amphotericin B[‘Ambisome’]. Also, weekly compresses soaked inamphotericin B were applied.
Induction therapy was reinstated 3 weeks after surgery. Theman stopped liposomal amphotericin B after a total of 40 days’treatment, and started oral itraconazole. He then receivedconsolidation therapy. Up until his death from diseaseprogression approximately 8 months later, he did notexperience any further signs or symptoms of recurrent mycoticinfection.Lerchenmuller C, et al. Rhinocerebral zygomycosis in a patient with acutelymphoblastic leukemia. Annals of Oncology 12: 415-419, Mar 2001 -Germany 800865363
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Reactions 23 Jun 2001 No. 8570114-9954/10/0857-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
