14th ICID - Poster Abstracts - International Society for Infectious ...

When citing these abstracts please use the following reference:
Author(s) of abstract. Title of abstract [abstract]. Int J Infect Dis 2010;14S1: Abstract number.
Please note that the official publication of the International Journal of Infectious Diseases 2010, Volume 14, Supplement 1
is available electronically on http://www.sciencedirect.com
Final Abstract Number: 30.013
Session: Mycology, Fungal Infections and Antifungal Drugs
Date: Wednesday, March 10, 2010
Time: 12:30-13:30
Room: Poster & Exhibition Area/Ground Level
Type: Poster Presentation
Breakthrough Rhizopus spp. in an immunocompromised patient receiving caspofungin. Case
Report and review
N. Dunkel, J. Ambrosioni, Y. Chalandon, J. Passweg, J. garbino
University Hospital of Geneva, Geneva, Switzerland
Background: Invasive zygomycosis is a rare opportunistic fungal disease, with high morbidity
and mortality rates that affects predominantly immunosuppressed patients. An increase incidence
is observed with the widespread use of newer antifungal drugs, such as voriconazol and
caspofungin. We report a case of breakthrough invasive zygomycosis in a stem cell transplant
recipient on sequential voriconazole and caspofungin treatment, and we review the previous
published cases.
Methods: Analysis of a clinical case with zygomycosis breakthrough infection and review of
previous published cases.
Results: To date, seven cases of immunocompromised patient with breakthrough zygomycosis
infection receiving caspofungin were published (Table 1)
In September 2007, a 51 year old female patient was admitted for myelodysplastic syndrome
RAEB-T, diagnosed a year before. A related allogenic hematopoietic stem cells transplant
(HSCT) (HLA 9/10) was performed. On October 12th, the patient developed an hepatic GVHD,
treated by prednisone. The clinical evolution was good and the patient was discharged of the
hospital on October 29th on prednisone, cyclosporine, penicillin V, valaciclovir, voriconazole, cotrimoxazole
and folinic acid. These treatments were stopped 6 weeks later.
On January 3rd, the patient was readmitted presenting a febrile state and aqueous diarrhea. An
acute digestive GVHD was diagnosed and large spectrum antimicrobial treatment was initiated.
Voriconazole was switched to caspofungin on January 16th, due to liver tests enzymes alteration
After 1 week of treatment, a thoracic CT scan was performed and revealed signs of pulmonary
infection. Nasal swab and bronchoalveolar lavage cultures grew with Rhizopus spp. The patient
experienced an important clinical worsening. Considering the severity of infectious and
hematologic prognosis as well as the lack of clinical response, the physician according with the
family decided to stop aggressive therapy. The patients died 10 days later. The autopsy finding
showed that the death was due to a disseminated angioinvasive mycotic infection.
Conclusion: As reported with voriconazole, prolonged caspofungin treatment may be a risk
factor for invasive zygomycosis infection in immunocompromised patients. This disease must be
always considered in immunocompromised patient receiving caspofungin therapy.