Resolution of disseminated fusariosis in a child with acute leukemia treated with combined antifungal therapy: a case report

• Published in: BMC infectious diseases 2007-05, Vol.7 (1), p.40-40, Article 40
• Main Authors: Vagace, José-Manuel, Sanz-Rodriguez, Cesar, Casado, Maria-Soledad, Alonso, Nieves, Garcia-Dominguez, Manuel, de la Llana, Francisco Garcia, Zarallo, Luis, Fajardo, Miguel, Bajo, Roberto
• Format: Article
• Language: English
• Subjects: Amphotericin B - administration & dosage; Amphotericin B - therapeutic use; Antifungal agents; Antifungal Agents - administration & dosage; Antifungal Agents - therapeutic use; Case Report; Case studies; Child; Complications and side effects; Development and progression; Dosage and administration; Drug therapy; Drug Therapy, Combination; Echinocandins; Female; Fusarium; Fusarium - classification; Fusarium - drug effects; Humans; Leukemia; Lipopeptides; Mycoses - complications; Mycoses - drug therapy; Mycoses - microbiology; Peptides, Cyclic - administration & dosage; Peptides, Cyclic - therapeutic use; Precursor Cell Lymphoblastic Leukemia-Lymphoma - complications; Pyrimidines - administration & dosage; Pyrimidines - therapeutic use; Treatment Outcome; Triazoles - administration & dosage; Triazoles - therapeutic use; Voriconazole
• ISSN: 1471-2334; 1471-2334
• DOI: 10.1186/1471-2334-7-40

Fusarium spp. is being isolated with increasing frequency as a pathogen in oncohematologic patients. Caspofungin and amphotericin B have been reported to have synergistic activity against Fusarium spp. We herein report a case of disseminated fusariosis diagnosed by chest CT scan and positive blood cultures to Fusarium spp. Because the patient's clinical condition deteriorated, CRP levels increased, and blood cultures continued to yield Fusarium spp. despite liposomal amphotericin B monotherapy up to 5 mg/kg daily, treatment with caspofungin was added. Within 2 weeks of onset of combined antifungal therapy, the chest CT scan demonstrated a progressive resolution of the pulmonary lesions. Upon discontinuation of intravenous antifungals, the patient received suppressive therapy with oral voriconazole. Three months later, a chest CT scan showed no abnormalities. Twenty-five months after discontinuation of all antifungal therapy, the patient remains in complete remission of her neoplastic disease with no signs of clinical activity of the Fusarium infection. This is the first description of successful treatment of disseminated fusariosis in a pediatric patient with acute lymphoblastic leukemia with caspofungin and amphotericin B followed by oral suppressive therapy with voriconazole.