Successful Treatment of Pneumonia caused by Aspergillus terrerus and Cytomegalovirus after Chemotherapy for Acute Myelogenous Leukemia.
- Author:
Min Young LEE
1
;
Si Hyun KIM
;
Jae Cheol KWON
;
Dong Gun LEE
;
Seok Goo CHO
;
Sung Yeon CHO
;
You Mi HWANG
;
Mi Ae SONG
Author Information
- Publication Type:Case Report
- Keywords: Aspergillus terreus; Cytomegalovirus; Pneumonia; Leukemia; Myeloid; Acute
- MeSH: Amphotericin B; Antiviral Agents; Aspergillus; Cytomegalovirus; Deoxycholic Acid; Drug Combinations; Female; Fetal Blood; Fever; Foscarnet; Ganciclovir; Giant Cells; Hematopoietic Stem Cell Transplantation; Humans; Immunoassay; Intranuclear Inclusion Bodies; Leukemia; Leukemia, Myeloid, Acute; Lung; Mannans; Neutrophils; Pneumonia; Pyrimidines; Remission Induction; Thorax; Triazoles; Young Adult
- From:Infection and Chemotherapy 2012;44(1):26-30
- CountryRepublic of Korea
- Language:Korean
- Abstract: We report a case of pneumonia caused by Aspergillus terreus and cytomegalovirus (CMV) in a patient with acute myleogenous leukemia (AML) after remission induction chemotherapy. A 19-year-old woman underwent chemotherapy for AML. Twenty-three days after completing chemotherapy, she experienced a neutropenic fever with a rapidly-progressive pulmonary infiltration. In those days, her serum galactomannan immunoassay was 4.7 and she was treated with intravenous voriconazole (6 mg/kg q12h for 2 doses, followed by 4 mg/kg q12h) because of persistent fever and radiological worsening, despite the administration of amphotericin B deoxycholate (1 mg/kg q24h) for 7 days. A chest CT showed wedge-shaped consolidation with a central hypodense lesion and an air-crescent sign in the right middle lobe. With maintenance therapy of oral voriconazole for 10 weeks, a partial response was shown and neutrophil count was still less than 100/mm3. A lobectomy of the right middle lobe was performed. A. terreus was discovered from the lung tissue. At the same time, giant cells with intranuclear inclusions were found and immunohistochemical staining for CMV was positive. Ganciclovir (5 mg/kg q12h) was added to voriconazole therapy for 3 weeks after surgery, and then cord blood hematopoietic stem cell transplantation (HSCT) was performed. During HSCT, foscarnet (60 mg/kg q12h) was substituted for ganciclovir, and both antiviral agents were used alternatively due to CMV DNAemia. After 83 days from HSCT, the patient achieved successful engraftment and discharged without worsening the pneumonia.
