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Successful Treatment of Pulmonary Mucormycosis Caused by Cunninghamella bertholletiae with High-Dose Liposomal Amphotericin B (10 mg/kg/day) Followed by a Lobectomy in Cord Blood Transplant Recipients

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Abstract

Infection caused by Cunninghamella bertholletiae carries one of the highest mortality rates among mucormycosis, and there are no reported cases that survived from the infection in allogeneic hematopoietic stem cell transplantation recipients occurring before neutrophil engraftment. Here, we present two cases of pulmonary mucormycosis caused by C. bertholletiae occurring before neutrophil engraftment after cord blood transplantation. Both were successfully treated with high-dose liposomal amphotericin B (10 mg/kg/day) combined with micafungin, which was then followed by neutrophil recovery, reduction in immunosuppressive agents, and a subsequent lobectomy. The intensive antifungal therapy immediately administered upon suspicion of mucormycosis greatly suppressed the infection in its early stage and was well tolerated despite its prolonged administration and simultaneous use of nephrotoxic agents after transplantation. Although the synergic effect of micafungin remains unclear, these cases highlight the importance of prompt administration of high-dose lipid polyene when suspecting mucormycosis in highly immunocompromised patients, which enables subsequent diagnostic and therapeutic interventions, resulting in a favorable outcome.

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Acknowledgements

This study was supported by the Research Program on Emerging and Re-emerging Infectious Diseases from Japan Agency for Medical Research and Development, AMED. We would like to thank all the physicians, nurses, pharmacists, and support personnel for their care of patients in this study (Grant no. H25-Shinko-Ippan-006).

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Authors and Affiliations

  1. Department of Hematology, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan

    Hikari Ota, Hisashi Yamamoto, Daisuke Kaji, Yuki Taya, Aya Nishida, Kazuya Ishiwata, Masanori Tsuji, Shinsuke Takagi, Yuki Asano-Mori, Go Yamamoto, Naoyuki Uchida, Koji Izutsu, Kazuhiro Masuoka, Atsushi Wake & Shuichi Taniguchi

  2. Department of Transfusion Medicine, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, Japan

    Hikari Ota & Shigeyoshi Makino

  3. Department of Infectious Diseases, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, Japan

    Muneyoshi Kimura, Hideki Araoka & Akiko Yoneyama

  4. Department of Pathology, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, Japan

    Takeshi Fujii

  5. Department of Chemotherapy and Mycoses, National Institute of Infectious Diseases, 1-23-1 Toyama, Shinjuku-ku, Tokyo, Japan

    Takashi Umeyama, Hideaki Ohno & Yoshitsugu Miyazaki

  6. Department of Infectious Diseases and Infection Control, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe-shi, Saitama, Japan

    Hideaki Ohno

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  1. Hikari Ota
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  2. Hisashi Yamamoto
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  3. Muneyoshi Kimura
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  4. Hideki Araoka
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  5. Takeshi Fujii
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  6. Takashi Umeyama
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  7. Hideaki Ohno
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  8. Yoshitsugu Miyazaki
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  9. Daisuke Kaji
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  10. Yuki Taya
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  13. Masanori Tsuji
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  14. Shinsuke Takagi
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  15. Yuki Asano-Mori
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  16. Go Yamamoto
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  17. Naoyuki Uchida
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  18. Koji Izutsu
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  19. Kazuhiro Masuoka
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  20. Atsushi Wake
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  21. Akiko Yoneyama
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  22. Shigeyoshi Makino
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Correspondence to Hisashi Yamamoto.

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Ota, H., Yamamoto, H., Kimura, M. et al. Successful Treatment of Pulmonary Mucormycosis Caused by Cunninghamella bertholletiae with High-Dose Liposomal Amphotericin B (10 mg/kg/day) Followed by a Lobectomy in Cord Blood Transplant Recipients. Mycopathologia 182, 847–853 (2017). https://doi.org/10.1007/s11046-017-0149-1

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  • DOI: https://doi.org/10.1007/s11046-017-0149-1

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