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Successful Treatment of Invasive Fungal Infection Due to Highly Resistant Aspergillus calidoustus in an Allogeneic Hematopoietic Cell Transplant Recipient

Abstract

Invasive aspergillosis (IA) is the most common invasive fungal infection following a hematopoietic cell transplant, with emerging cryptic species exhibiting resistance to commonly used antifungals such as azoles. These species have been increasingly found after the introduction of anti-mold prophylaxis. We report a case of a 56-year-old female with primary myelofibrosis whose allogeneic hematopoietic cell transplant was complicated by disseminated fungal infection (skin, lung) due to Aspergillus calidoustus, a cryptic specie. Treatment of Aspergillus species remains challenging as these cryptic species are usually resistant to azoles including voriconazole which is the first line of treatment of IA. Infection was successfully treated with surgical excision and combination antifungal therapy based on in vitro susceptibility and synergy testing. Therapy included isavuconazole, a drug that has been shown to be non-inferior to voriconazole in the treatment of invasive mold infections.

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Correspondence to Jose F. Camargo.

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The authors confirm that this material is original and has not been published in whole or in part elsewhere, that the manuscript was written attaining complete patient anonymity and that all authors reviewed and approved the final version. In addition, the authors confirm that they have completed the checklist for submission of a case report to Mycopathologia published by Bouchara et al. [15].

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Mendoza, M.A., Anderson, A., Morris, M.I. et al. Successful Treatment of Invasive Fungal Infection Due to Highly Resistant Aspergillus calidoustus in an Allogeneic Hematopoietic Cell Transplant Recipient. Mycopathologia (2020). https://doi.org/10.1007/s11046-019-00423-x

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Keywords

  • Aspergillus calidoustus
  • Invasive aspergillosis
  • Aspergillus ustus
  • Antifungal therapy
  • Cryptic species
  • Antifungal susceptibility testing
  • Isavuconazole