Abstract
A 57-year-old man with acute myeloid leukemia (AML) French-American-British (FAB) 4 developed disseminated invasive cerebral and pulmonary aspergillosis during postinduction aplasia. According to international consensus, infection was categorized as probable (two host factors: deep neutropenia for >10 days and refractory fever for >96 h; major clinical criteria of lower respiratory tract and CNS invasive fungal infection; positive results for galactomannan antigen in three blood samples). After the failure of standard amphotericin-based therapy, the spectacular regression of multifocal brain and lung lesions was rapidly achieved under a caspofungin acetate/voriconazole combination. Further permanent caspofungin maintenance with voriconazole added during aplasia periods permitted two consolidation courses and autograft-based intensification without any delay.
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References
Denning DW (1998) Invasive aspergillosis. Clin Infect Dis 26:781–803, quiz 804–805
Denning DW, Marinus A, Cohen J, et al. (1998) An EORTC multicentre prospective survey of invasive aspergillosis in haematological patients: diagnosis and therapeutic outcome. EORTC Invasive Fungal Infections Cooperative Group. J Infect 37:173–180
Lin SJ, Schranz J, Teutsch SM (2001) Aspergillosis case-fatality rate: systematic review of the literature. Clin Infect Dis 32:358–366
Patterson TF, Kirkpatrick WR, White M, et al. (2000) Invasive aspergillosis. Disease spectrum, treatment practices, and outcomes. I3 Aspergillus Study Group. Medicine (Baltimore) 79:250–260
Andriole VT (2000) Current and future antifungal therapy: new targets for antifungal therapy. Int J Antimicrob Agents 16:317–321
IDSA (2000) Practice guidelines for diseases caused by aspergillus. Clin Infect Dis 30:696–709
Herbrecht R, Denning DW, Patterson TF, et al. (2002) Voriconazole versus amphotericin B for primary therapy of invasive aspergillosis. N Engl J Med 347:408–415
Pacetti SA, Gelone SP (2003) Caspofungin acetate for treatment of invasive fungal infections. Ann Pharmacother 37:90–98
Perea S, Gonzalez G, Fothergill AW, Kirkpatrick WR, Rinaldi MG, Patterson TF (2002) In vitro interaction of caspofungin acetate with voriconazole against clinical isolates of Aspergillus spp. Antimicrob Agents Chemother 46:3039–3041
Kirkpatrick WR, Perea S, Coco BJ, Patterson TF (2002) Efficacy of caspofungin alone and in combination with voriconazole in a Guinea pig model of invasive aspergillosis. Antimicrob Agents Chemother 46:2564–2568
Ascioglu S, Rex JH, de Pauw B, et al. (2002) Defining opportunistic invasive fungal infections in immunocompromised patients with cancer and hematopoietic stem cell transplants: an international consensus. Clin Infect Dis 34:7–14
Caillot D, Casasnovas O, Bernard A, et al. (1997) Improved management of invasive pulmonary aspergillosis in neutropenic patients using early thoracic computed tomographic scan and surgery. J Clin Oncol 15:139–147
Barnes AJ, Oppenheim BA, Chang J, et al. (1999) Early investigation and initiation of therapy for invasive pulmonary aspergillosis in leukaemic and bone marrow transplant patients. Mycoses 42:403–408
Adler-Moore JP, Chiang SM, Satorius A, et al. (1991) Treatment of murine candidosis and cryptococcosis with a unilamellar liposomal amphotericin B formulation (AmBisome). J Antimicrob Chemother 28 [Suppl B]:63–71
Mahlknecht U, von Lintig F, Mertelsmann R, et al. (1997) Successful treatment of disseminated central nervous aspergillosis in a patient with acute myeloblastic leukemia. Leuk Lymphoma 27:191–194
Denning DW (1996) Therapeutic outcome in invasive aspergillosis. Clin Infect Dis 23:608–615
Herbrecht R, Denning DW, Patterson TF, et al. (2002) Voriconazole versus amphotericin B for primary therapy of invasive aspergillosis. N Engl J Med 347:408–415
Denning DW (2002) Echinocandins: a new class of antifungal. J Antimicrob Chemother 49:889–891
Maertens J, Raad I, Sable CA, et al. (2000) Multicenter noncomparative study to evaluate safety and efficacy of caspofungin in adults with invasive aspergillosis refractory or intolerant to amphotericin B, amB lipid formulations or azoles (abstract 1103:371). 40th ICAAC, Toronto, Ontario, Canada, 17–20 September 2000
Gatbois E, Adjaoud D, Larroquet M, et al. (2002) Successful treatment of disseminated aspergillosis by caspofungin and voriconazole in a leukemic child. J Mycol Med 12:90–92
Schwartz S, Milatovic D, Thiel E (1997) Successful treatment of cerebral aspergillosis with a novel triazole (voriconazole) in a patient with acute leukaemia. Br J Haematol 97:663–665
Nesky MA, McDougal EC, Peacock JE Jr (2000) Pseudallescheria boydii brain abscess successfully treated with voriconazole and surgical drainage: case report and literature review of central nervous system pseudallescheriasis. Clin Infect Dis 31:673–677
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Damaj, G., Ivanov, V., Le Brigand, B. et al. Rapid improvement of disseminated aspergillosis with caspofungin/voriconazole combination in an adult leukemic patient. Ann Hematol 83, 390–393 (2004). https://doi.org/10.1007/s00277-003-0792-0
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DOI: https://doi.org/10.1007/s00277-003-0792-0