Journal List > Infect Chemother > v.44(6) > 1035221

Kim, Kong, Kim, Kim, Lee, Lee, Lee, Cho, Lee, and Lee: A Case of Disseminated Candidiasis and Subsequent Breakthrough Pulmonary Mucormycosis after Consolidation Chemotherapy for Acute Myeloid Leukemia

Abstract

Invasive fungal infections (IFIs) are an important cause of morbidity and mortality in patients with acute leukemia who are receiving chemotherapy. Primary prophylaxis with antifungal agents has become the standard of care in this setting; as a result, invasive candidiasis has shown a significant reduction. However, broad use of antifungal prophylaxis has led to an increase in breakthrough candidiasis with reduced susceptibility or resistance to fluconazole. In addition, an increase in breakthrough mucormycosis has been reported in studies of voriconazole prophylaxis. We report on a case of disseminated candidiasis and subsequent breakthrough pulmonary mucormycosis in a patient with acute myeloid leukemia undergoing consolidation chemotherapy. To the best of our knowledge, in Korea, this is the first report of these two independent IFIs occurring in a single patient.

Figures and Tables

Figure 1
(A) CT scan shows numerous micronodules in the liver; the spleen, in which similar tiny hypodense lesions had been seen, had been excised surgically. (B) Both pseudohyphae and the yeast form of Candida are observed in the microabscess. (Periodic Acid Schiff stain, ×1,000)
ic-44-544-g001
Figure 2
(A) CT scan shows a round consolidation in the left lower lobe of the lung, with a low attenuating necrotic area within. Still observed are numerous tiny nodules in the hepatic dome. (B) Microscopic view of the biopsy specimen shows numerous short folded hyphae with broad and right angle budding, which are characteristic of mucormycosis, within the abscess. (Hematoxylin & Eosin stain, ×1,000)
ic-44-544-g002
Figure 3
Schematic presentation of the patient's clinical course.
ICZ, Itraconazole; AMB, Amphotericin B deoxycholate; VCZ, Voriconazole; PCZ, Posaconazole.
ic-44-544-g003

References

1. Robenshtok E, Gafter-Gvili A, Goldberg E, Weinberger M, Yeshurun M, Leibovici L, Paul M. Antifungal prophylaxis in cancer patients after chemotherapy or hematopoietic stem-cell transplantation: systematic review and meta-analysis. J Clin Oncol. 2007. 25:5471–5489.
crossref
2. Bow EJ, Laverdière M, Lussier N, Rotstein C, Cheang MS, Ioannou S. Antifungal prophylaxis for severely neutropenic chemotherapy recipients: a meta analysis of randomized-controlled clinical trials. Cancer. 2002. 94:3230–3246.
crossref
3. Enoch DA, Ludlam HA, Brown NM. Invasive fungal infections: a review of epidemiology and management options. J Med Microbiol. 2006. 55:809–818.
crossref
4. Freifeld AG, Bow EJ, Sepkowitz KA, Boeckh MJ, Ito JI, Mullen CA, Raad II, Rolston KV, Young JA, Wingard JR. Infectious Diseases Society of America. Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 update by the infectious diseases society of america. Clin Infect Dis. 2011. 52:e56–e93.
crossref
5. Wingard JR, Merz WG, Rinaldi MG, Johnson TR, Karp JE, Saral R. Increase in Candida krusei infection among patients with bone marrow transplantation and neutropenia treated prophylactically with fluconazole. N Engl J Med. 1991. 325:1274–1277.
crossref
6. Marty FM, Cosimi LA, Baden LR. Breakthrough zygomycosis after voriconazole treatment in recipients of hematopoietic stem-cell transplants. N Engl J Med. 2004. 350:950–952.
crossref
7. Imhof A, Balajee SA, Fredricks DN, Englund JA, Marr KA. Breakthrough fungal infections in stem cell transplant recipients receiving voriconazole. Clin Infect Dis. 2004. 39:743–746.
crossref
8. Trifilio S, Singhal S, Williams S, Frankfurt O, Gordon L, Evens A, Winter J, Tallman M, Pi J, Mehta J. Breakthrough fungal infections after allogeneic hematopoietic stem cell transplantation in patients on prophylactic voriconazole. Bone Marrow Transplant. 2007. 40:451–456.
crossref
9. Kontoyiannis DP, Lionakis MS, Lewis RE, Chamilos G, Healy M, Perego C, Safdar A, Kantarjian H, Champlin R, Walsh TJ, Raad II. Zygomycosis in a tertiary-care cancer center in the era of Aspergillus-active antifungal therapy: a case-control observational study of 27 recent cases. J Infect Dis. 2005. 191:1350–1360.
crossref
10. Siwek GT, Dodgson KJ, de Magalhaes-Silverman M, Bartelt LA, Kilborn SB, Hoth PL, Diekema DJ, Pfaller MA. Invasive zygomycosis in hematopoietic stem cell transplant recipients receiving voriconazole prophylaxis. Clin Infect Dis. 2004. 39:584–587.
crossref
11. Cornely OA, Maertens J, Winston DJ, Perfect J, Ullmann AJ, Walsh TJ, Helfgott D, Holowiecki J, Stockelberg D, Goh YT, Petrini M, Hardalo C, Suresh R, Angulo-Gonzalez D. Posaconazole vs. fluconazole or itraconazole prophylaxis in patients with neutropenia. N Engl J Med. 2007. 356:348–359.
crossref
12. Kontoyiannis DP, Luna MA, Samuels BI, Bodey GP. Hepatosplenic candidiasis. A manifestation of chronic disseminated candidiasis. Infect Dis Clin North Am. 2000. 14:721–739.
13. Leventakos K, Lewis RE, Kontoyiannis DP. Fungal infections in leukemia patients: how do we prevent and treat them? Clin Infect Dis. 2010. 50:405–415.
crossref
14. Lee DG, Kim SH, Kim SY, Kim CJ, Park WB, Song YG, Choi JH. Evidence-based guidelines for empirical therapy of neutropenic fever in Korea. Korean J Intern Med. 2011. 26:220–252.
crossref
15. Kontoyiannis DP, Luna MA, Samuels BI, Bodey GP. Hepatosplenic candidiasis. A manifestation of chronic disseminated candidiasis. Infect Dis Clin North Am. 2000. 14:721–739.
TOOLS
ORCID iDs

Dong-Gun Lee
https://orcid.org/http://orcid.org/0000-0003-4655-0641

Similar articles