1. Introduction Imagine result Case Report Comment
Dematiaceus fungi related pulmonary infection post hematopoietic stem cell transplantation from a haploidentical donor: a case report
Al Shaibani Eshrak, Al Yousef W, Mokhtar Nihad, Kawari Mohammed, Bakhit Khalid, Abulhassan Ayman, Alharbi Salman, Suhebeh Ashraf, Soudi Hamdi, Apostolidis John, Hani Al Hasmi, Khalid Al Anezi, Kaloyannidis Panayotis
Adults Hematology and Stem Cell Transplantation Department
King Fahad Specialist Hospital Dammam Saudi Arabia
Introduction
Imagine result
Dematiaceous fungi (DF) infections are increasingly seen in allografted and immunocompromised patients, affecting usually skin, lungs, brain while also disseminated disease has been reported.
No standardized therapy exists, triazoles and Liposomal-Amphotericin-B (L-AmB) have been successfully used as treatment.
Sputum culture:
- Satin by lactophenol examination, confirm the
diagnosis.
Treatment:
- Posaconazole (200mg tid) plus IV L-AmB (5mg/kg).
Response:
- Symptoms completely resolved after 7 days.
- Repeated sputum cultures revealed no detectable DF.
- Posaconazole continue as maintenance .
- 3 months later, she remains in complete remission
without evidence of fungal infection.
Case Report
An 35 years old female, who underwent allogeneic stem cell transplantation from a haploidentical donor for localized (mediastinum) myeloid sarcοma.
Clinical course:
Pre-transplant:
- Cytarabine and Idarubicin (3+7 regimen).
- High-dose Cytarabine (3 cycles).
- Involved field irradiation.
Transplant course:
- Conditioning regimen consisted of Thiotepa / Busulfan/
Fludarabine.
- CD34+ cell 4.5x106/kg unmanipulated from peripheral
blood.
- GvHD prophlaxsis:
Post-transplant Cyclophosphamide (days: +3, +5).
Cyclosporine (CSP).
Mycophenolate Mofetil (MMF)
- Antibiotic prophylaxis:
Fluoroquinolone, acyclovir and voriconazole.
Post transplant:
- Engraftment ANCs>500/mm3 (day +18)
PLTs>25000/mm3 (day +11) while from
- Day+14 chimeric study 100%.
- Complication:
* Day+14: acute-GvHD(grII) that successfully controlled with steroids additionally to CSP and MMF.
* Day+30: productive cough, without fever was not
responding to antibiotics.
Comment
Heavily immunosuppressed patient, the combination of Posaconazole plus L-AmB proved to be highly effective.
Combined antifungal treatment for these aggressive DF infections needs further investigation