Eradication of Pulmonary Aspergillosis in an Adolescent Patient Undergoing Three Allogeneic Stem Cell Transplantations for Acute Lymphoblastic Leukemia
Systemic fungal infections are a major cause of infection-related mortality in patients with hematologic malignancies. This report addresses the case of an adolescent patient with acute lymphoblastic leukemia who underwent three allogeneic hematopoietic stem cell transplantations and developed pulmo...
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| Format: | Article |
| Language: | English |
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Wiley
2012-01-01
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| Series: | Case Reports in Transplantation |
| Online Access: | http://dx.doi.org/10.1155/2012/672923 |
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| author | Michaela Döring Angelika Zierl Markus Mezger Peter Lang Rupert Handgretinger Ingo Müller |
| author_facet | Michaela Döring Angelika Zierl Markus Mezger Peter Lang Rupert Handgretinger Ingo Müller |
| author_sort | Michaela Döring |
| collection | DOAJ |
| description | Systemic fungal infections are a major cause of infection-related mortality in patients with hematologic malignancies. This report addresses the case of an adolescent patient with acute lymphoblastic leukemia who underwent three allogeneic hematopoietic stem cell transplantations and developed pulmonary aspergillosis. Combination therapy with liposomal amphotericin B (L-AmB, 3 mg/kg bw/day) and caspofungin (CAS, 50 mg/day) during the first allogeneic hematopoietic stem cell transplantation (HSCT) improved the pulmonary situation. After shifting the antifungal combination therapy to oral voriconazole (2 × 200 mg/day) and CAS, a new pulmonal lesion occurred alongside the improvements in the existing pulmonary aspergillosis. An antifungal combination during a second HSCT with L-AmB (3 mg/kg bw/day) and CAS showed an improvement in the pulmonary aspergillosis. A combination therapy with CAS and L-AmB (1 mg/kg bw/day) during the third HSCT led once again to progress the pulmonary aspergillosis, after increasing the L-AMB to 3 mg/kg bw/day for recovery. The presented case provides an example of how, despite severe immunosuppression, a combination of antifungal drugs administered intravenously at therapeutic dosages may be more efficient than either intravenous monotherapy or combinations of intravenous and oral antifungals in selecting pediatric and adolescent patients with proven fungal infections. |
| format | Article |
| id | doaj-art-7e3eaf6491c243568942469c2ef15d80 |
| institution | Kabale University |
| issn | 2090-6943 2090-6951 |
| language | English |
| publishDate | 2012-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Case Reports in Transplantation |
| spelling | doaj-art-7e3eaf6491c243568942469c2ef15d802025-08-20T03:35:33ZengWileyCase Reports in Transplantation2090-69432090-69512012-01-01201210.1155/2012/672923672923Eradication of Pulmonary Aspergillosis in an Adolescent Patient Undergoing Three Allogeneic Stem Cell Transplantations for Acute Lymphoblastic LeukemiaMichaela Döring0Angelika Zierl1Markus Mezger2Peter Lang3Rupert Handgretinger4Ingo Müller5Department of Pediatric Hematology/Oncology, University Children’s Hospital Tübingen, Hoppe-Seyler-Strß 1, 72076 Tübingen, GermanyDepartment of Pediatric Diagnostic Radiology, Olga-Hospital Stuttgart, Bismarckstraß 8, 70176 Stuttgart, GermanyDepartment of Pediatric Hematology/Oncology, University Children’s Hospital Tübingen, Hoppe-Seyler-Strß 1, 72076 Tübingen, GermanyDepartment of Pediatric Hematology/Oncology, University Children’s Hospital Tübingen, Hoppe-Seyler-Strß 1, 72076 Tübingen, GermanyDepartment of Pediatric Hematology/Oncology, University Children’s Hospital Tübingen, Hoppe-Seyler-Strß 1, 72076 Tübingen, GermanyDepartment of Pediatric Hematology/Oncology, University Children’s Hospital Tübingen, Hoppe-Seyler-Strß 1, 72076 Tübingen, GermanySystemic fungal infections are a major cause of infection-related mortality in patients with hematologic malignancies. This report addresses the case of an adolescent patient with acute lymphoblastic leukemia who underwent three allogeneic hematopoietic stem cell transplantations and developed pulmonary aspergillosis. Combination therapy with liposomal amphotericin B (L-AmB, 3 mg/kg bw/day) and caspofungin (CAS, 50 mg/day) during the first allogeneic hematopoietic stem cell transplantation (HSCT) improved the pulmonary situation. After shifting the antifungal combination therapy to oral voriconazole (2 × 200 mg/day) and CAS, a new pulmonal lesion occurred alongside the improvements in the existing pulmonary aspergillosis. An antifungal combination during a second HSCT with L-AmB (3 mg/kg bw/day) and CAS showed an improvement in the pulmonary aspergillosis. A combination therapy with CAS and L-AmB (1 mg/kg bw/day) during the third HSCT led once again to progress the pulmonary aspergillosis, after increasing the L-AMB to 3 mg/kg bw/day for recovery. The presented case provides an example of how, despite severe immunosuppression, a combination of antifungal drugs administered intravenously at therapeutic dosages may be more efficient than either intravenous monotherapy or combinations of intravenous and oral antifungals in selecting pediatric and adolescent patients with proven fungal infections.http://dx.doi.org/10.1155/2012/672923 |
| spellingShingle | Michaela Döring Angelika Zierl Markus Mezger Peter Lang Rupert Handgretinger Ingo Müller Eradication of Pulmonary Aspergillosis in an Adolescent Patient Undergoing Three Allogeneic Stem Cell Transplantations for Acute Lymphoblastic Leukemia Case Reports in Transplantation |
| title | Eradication of Pulmonary Aspergillosis in an Adolescent Patient Undergoing Three Allogeneic Stem Cell Transplantations for Acute Lymphoblastic Leukemia |
| title_full | Eradication of Pulmonary Aspergillosis in an Adolescent Patient Undergoing Three Allogeneic Stem Cell Transplantations for Acute Lymphoblastic Leukemia |
| title_fullStr | Eradication of Pulmonary Aspergillosis in an Adolescent Patient Undergoing Three Allogeneic Stem Cell Transplantations for Acute Lymphoblastic Leukemia |
| title_full_unstemmed | Eradication of Pulmonary Aspergillosis in an Adolescent Patient Undergoing Three Allogeneic Stem Cell Transplantations for Acute Lymphoblastic Leukemia |
| title_short | Eradication of Pulmonary Aspergillosis in an Adolescent Patient Undergoing Three Allogeneic Stem Cell Transplantations for Acute Lymphoblastic Leukemia |
| title_sort | eradication of pulmonary aspergillosis in an adolescent patient undergoing three allogeneic stem cell transplantations for acute lymphoblastic leukemia |
| url | http://dx.doi.org/10.1155/2012/672923 |
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