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Fatal breakthrough mucormycosis in a multivisceral transplant patient receiving micafungin: Case report and literature review

INTRODUCTION: Antifungal agents are routinely used in the post-transplant setting for both prophylaxis and treatment of presumed and proven fungal infections. Micafungin is an echinocandin-class antifungal with broad antifungal cover and favorable side effect profile but, notably, it has no activity...

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Autores principales: Louis-Auguste, John R., Micallef, Christianne, Ambrose, Tim, Upponi, Sara, Butler, Andrew J., Massey, Dunecan, Middleton, Stephen J., Russell, Neil, Rutter, Charlotte S., Sharkey, Lisa M., Woodward, Jeremy, Gkrania-Klotsas, Effrossyni, Enoch, David A.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6010962/
https://www.ncbi.nlm.nih.gov/pubmed/29942755
http://dx.doi.org/10.1016/j.idcr.2018.03.017
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author Louis-Auguste, John R.
Micallef, Christianne
Ambrose, Tim
Upponi, Sara
Butler, Andrew J.
Massey, Dunecan
Middleton, Stephen J.
Russell, Neil
Rutter, Charlotte S.
Sharkey, Lisa M.
Woodward, Jeremy
Gkrania-Klotsas, Effrossyni
Enoch, David A.
author_facet Louis-Auguste, John R.
Micallef, Christianne
Ambrose, Tim
Upponi, Sara
Butler, Andrew J.
Massey, Dunecan
Middleton, Stephen J.
Russell, Neil
Rutter, Charlotte S.
Sharkey, Lisa M.
Woodward, Jeremy
Gkrania-Klotsas, Effrossyni
Enoch, David A.
author_sort Louis-Auguste, John R.
collection PubMed
description INTRODUCTION: Antifungal agents are routinely used in the post-transplant setting for both prophylaxis and treatment of presumed and proven fungal infections. Micafungin is an echinocandin-class antifungal with broad antifungal cover and favorable side effect profile but, notably, it has no activity against molds of the order Mucorales. PRESENTATION OF CASE: A 47-year-old woman underwent multivisceral transplantation for intestinal failure-associated liver disease. She had a prolonged post-operative recovery complicated by invasive candidiasis and developed an intolerance to liposomal amphotericin B. In view of her immunosuppression, she was commenced on micafungin as prophylaxis to prevent invasive fungal infection. However, she developed acute graft versus host disease with bone marrow failure complicated by disseminated mucormycosis which was only diagnosed post mortem. DISCUSSION: Non-Aspergillus breakthrough mold infections with micafungin therapy are rare with only eight other cases having been described in the literature. Breakthrough infections have occurred within one week of starting micafungin. Diagnosis is problematic and requires a high degree of clinical suspicion and microscopic/histological examination of an involved site. The management of these aggressive infections involves extensive debridement and appropriate antifungal cover. CONCLUSION: A high level of suspicion of invasive fungal infection is required at all times in immunosuppressed patients, even those receiving antifungal prophylaxis. Early biopsy is required. Even with early recognition and aggressive treatment of these infections, prognosis is poor.
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spelling pubmed-60109622018-06-25 Fatal breakthrough mucormycosis in a multivisceral transplant patient receiving micafungin: Case report and literature review Louis-Auguste, John R. Micallef, Christianne Ambrose, Tim Upponi, Sara Butler, Andrew J. Massey, Dunecan Middleton, Stephen J. Russell, Neil Rutter, Charlotte S. Sharkey, Lisa M. Woodward, Jeremy Gkrania-Klotsas, Effrossyni Enoch, David A. IDCases Article INTRODUCTION: Antifungal agents are routinely used in the post-transplant setting for both prophylaxis and treatment of presumed and proven fungal infections. Micafungin is an echinocandin-class antifungal with broad antifungal cover and favorable side effect profile but, notably, it has no activity against molds of the order Mucorales. PRESENTATION OF CASE: A 47-year-old woman underwent multivisceral transplantation for intestinal failure-associated liver disease. She had a prolonged post-operative recovery complicated by invasive candidiasis and developed an intolerance to liposomal amphotericin B. In view of her immunosuppression, she was commenced on micafungin as prophylaxis to prevent invasive fungal infection. However, she developed acute graft versus host disease with bone marrow failure complicated by disseminated mucormycosis which was only diagnosed post mortem. DISCUSSION: Non-Aspergillus breakthrough mold infections with micafungin therapy are rare with only eight other cases having been described in the literature. Breakthrough infections have occurred within one week of starting micafungin. Diagnosis is problematic and requires a high degree of clinical suspicion and microscopic/histological examination of an involved site. The management of these aggressive infections involves extensive debridement and appropriate antifungal cover. CONCLUSION: A high level of suspicion of invasive fungal infection is required at all times in immunosuppressed patients, even those receiving antifungal prophylaxis. Early biopsy is required. Even with early recognition and aggressive treatment of these infections, prognosis is poor. Elsevier 2018-03-24 /pmc/articles/PMC6010962/ /pubmed/29942755 http://dx.doi.org/10.1016/j.idcr.2018.03.017 Text en © 2018 The Authors http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Article
Louis-Auguste, John R.
Micallef, Christianne
Ambrose, Tim
Upponi, Sara
Butler, Andrew J.
Massey, Dunecan
Middleton, Stephen J.
Russell, Neil
Rutter, Charlotte S.
Sharkey, Lisa M.
Woodward, Jeremy
Gkrania-Klotsas, Effrossyni
Enoch, David A.
Fatal breakthrough mucormycosis in a multivisceral transplant patient receiving micafungin: Case report and literature review
title Fatal breakthrough mucormycosis in a multivisceral transplant patient receiving micafungin: Case report and literature review
title_full Fatal breakthrough mucormycosis in a multivisceral transplant patient receiving micafungin: Case report and literature review
title_fullStr Fatal breakthrough mucormycosis in a multivisceral transplant patient receiving micafungin: Case report and literature review
title_full_unstemmed Fatal breakthrough mucormycosis in a multivisceral transplant patient receiving micafungin: Case report and literature review
title_short Fatal breakthrough mucormycosis in a multivisceral transplant patient receiving micafungin: Case report and literature review
title_sort fatal breakthrough mucormycosis in a multivisceral transplant patient receiving micafungin: case report and literature review
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6010962/
https://www.ncbi.nlm.nih.gov/pubmed/29942755
http://dx.doi.org/10.1016/j.idcr.2018.03.017
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