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Voriconazole for both successful treatment of disseminated Trichosporon asahii infection and subsequent cord blood transplantation in an infant with acute myelogenous leukemia

Bone Marrow Transplantation volume 46, pages 310–311 (2011)Cite this article

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Disseminated Trichosporon infection is an uncommon but life-threatening fungal infection usually observed in immunocompromised hosts, especially in patients with hematological malignancies.1 The outcome of disseminated trichosporonosis is usually poor, with a mortality rate of approximately 80%.1 Although previous reports suggest that voriconazole (VRCZ) is efficacious,1, 2, 3 clinical data on VRCZ therapy in pediatric patients are limited.3, 4 Even if this infection is successfully treated, subsequent chemotherapy and/or hematopoietic SCT (HSCT) will be challenging. To our knowledge, there have been no reports on successful HSCT after disseminated trichosporonosis. Here, we report using VRCZ for both successful treatment of disseminated Trichosporon asahii infection and for subsequent cord blood transplantation in an infant with AML.

In March 2007, a 5-month-old girl with acute megakaryoblastic leukemia with t(1;22)(p13;q13) abnormality was started on induction chemotherapy and achieved a CR. She continued in CR after the first course of consolidation chemotherapy and received the second course consisting of cytarabine, mitoxantrone and etoposide in June 2007. At 12 days after the initiation of chemotherapy, her WBC count decreased to 0.05 × 109/L and she developed high fever. She was treated with panipenem/betamipron, minocycline, fosfluconazole and granulocyte CSF, and her fever subsided on the following day. At 4 days after the first episode of fever, she became febrile again and several erythematous papules appeared on her face and trunk (day 0). The antibiotics were changed to vancomycin and cefpirome, but high fever persisted. On day 2, her blood culture from day 0 was reported to be positive for a yeast-like fungus and micafungin was added to the chemotherapy. However, high fever persisted and she had mild respiratory distress on day 3. On day 4, the yeast-like fungus was identified as Trichosporon species and T. asahii DNA was subsequently detected by PCR. The minimum inhibitory concentrations of amphotericin B, 5-fluorocytosine, fluconazole, miconazole, itraconazole, micafungin and VRCZ against the T. asahii isolate were 2, >64, 4, 0.5, 1, >16 and 0.125 μg/mL, respectively. Serum cryptococcal Ag was found to be positive and antifungal agents were changed to i.v. VRCZ (6 mg/kg every 12 h on the first day and 4 mg/kg every 12 h on the following days). Although serum β-D-glucan was transiently positive on day 6 and day 8, the patient's blood cultures became negative after VRCZ therapy was begun and her temperature decreased to a low-grade fever with improvement in exanthema and respiratory distress on day 10. The VRCZ trough plasma concentration on day 11 was 1.07 μg/mL. On day 14, her WBC count and neutrophil count increased to greater than 1.0 × 109/L and 0.5 × 109/L, respectively, and on day 19 her low-grade fever subsided. At this time, the serum cryptococcal Ag was still positive and VRCZ was administered orally from day 32 (4 mg/kg every 12 h).

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Acknowledgements

We thank Dr Takashi Sugita (Department of Microbiology, Meiji Pharmaceutical University) for PCR analysis and measurement of MICs, and Dr Issei Tokimatsu (Department of Infectious Diseases, Oita University Faculty of Medicine) for helpful advice on diagnosis and treatment.

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  1. Department of Pediatrics, Hirosaki University Graduate School of Medicine, Hirosaki, Japan

    K Kudo, K Terui, S Sasaki, T Kamio, T Sato & E Ito

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  1. K Kudo
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Correspondence to K Terui.

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Kudo, K., Terui, K., Sasaki, S. et al. Voriconazole for both successful treatment of disseminated Trichosporon asahii infection and subsequent cord blood transplantation in an infant with acute myelogenous leukemia. Bone Marrow Transplant 46, 310–311 (2011). https://doi.org/10.1038/bmt.2010.96

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