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Salvage Therapy of Refractory Chronic Disseminated Candidiasis in a Patient with Acute Myeloid Leukaemia and Secondary Prophylaxis During Allogeneic Stem Cell Transplantation
Author(s) -
Vehreschild Jörg J.,
Krüger Karsten,
Kurzai Oliver,
Wickenhauser Claudia,
Behringer Karolin,
Töx Ulrich,
Cornely Oliver A.
Publication year - 2006
Publication title -
mycoses
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.13
H-Index - 69
eISSN - 1439-0507
pISSN - 0933-7407
DOI - 10.1111/j.1439-0507.2006.01302.x
Subject(s) - medicine , refractory (planetary science) , transplantation , stem cell , salvage therapy , chronic myeloid leukaemia , myeloid leukaemia , secondary prophylaxis , surgery , chemotherapy , astrobiology , biology , physics , genetics
Summary We report on the treatment course of a 27‐year‐old male patient with acute myeloid leukaemia M1 and chronic disseminated candidiasis. After induction chemotherapy, the patient developed oesophageal candidiasis while participating in a voriconazole vs. placebo prophylaxis trial. He was then switched to oral fluconazole 400 mg q.i.d. After 6 days of futile fluconazole therapy he was switched to caspofungin 50 mg q.i.d. Caspofungin dose was later increased to 100 mg q.i.d after disseminated candidiasis with involvement of lung, spleen and liver was diagnosed. Following 63 days of caspofungin without resolution of symptoms, i.e. being persistently febrile, and emergence of soft tissue Candida abscesses, he was included into a trial allowing compassionate use of posaconazole as salvage therapy for refractory invasive fungal infections. Symptoms rapidly resolved under posaconazole 200 mg q.i.d. treatment and the patient was able to undergo allogeneic haematopoietic stem cell transplantation on secondary prophylaxis with posaconazole.