amphotericin-b and Abdominal-Neoplasms

Histoplasmosis is an endemic fungus in several regions of the United States. The diagnosis and treatment of this infection can be challenging in pediatric oncology patients. We present 5 patients diagnosed with histoplasmosis while receiving treatment at a midsize pediatric oncology center in Iowa. Two cases occurred in patients with acute lymphoblastic leukemia and 3 cases in patients with solid tumors. All patients were treated with antifungal therapy and demonstrated excellent clinical response. Histoplasmosis should be considered as a potential cause of nonspecific febrile illness, pulmonary masses, and bone marrow suppression in immunocompromised patients in endemic regions. Prompt and accurate diagnosis can facilitate timely antifungal therapy and avoidance of prolonged hospital stays, invasive testing, unnecessary antibiotics, and unwarranted anticancer therapies.

Topics: Abdominal Neoplasms; Adolescent; Amphotericin B; Antifungal Agents; Antineoplastic Combined Chemotherapy Protocols; Bone Marrow; Burkitt Lymphoma; Child; Child, Preschool; Combined Modality Therapy; Desmoplastic Small Round Cell Tumor; Diagnosis, Differential; Early Diagnosis; Endemic Diseases; Febrile Neutropenia; Histoplasmosis; Humans; Immunocompromised Host; Infant; Iowa; Itraconazole; Lung; Lung Neoplasms; Opportunistic Infections; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Sarcoma

Invasive fungal infections are serious complications of cancer therapy. We present a case report of a 12-year-old boy diagnosed with abdominal non-Hodgkin lymphoma and fecal and Candida peritonitis during induction chemotherapy. The invasive mycosis was managed using a combined approach of systemic antifungal agents including efungumab and surgical interventions. Efungumab, a recombinant antibody that inhibits extracellular heat shock protein 90, was used in combination with amphotericin B colloid dispersion after the failure of standard approaches.

Topics: Abdominal Neoplasms; Amphotericin B; Antibodies, Monoclonal; Antibodies, Monoclonal, Humanized; Antifungal Agents; Candidiasis; Child; Drug Therapy, Combination; HSP90 Heat-Shock Proteins; Humans; Lymphoma, Non-Hodgkin; Male; Peritonitis

A case of candida meningitis occurring in a child treated for a lymphoma is reported. Diagnosis was made with Candida albicans culture in the CSF. Blood cultures were negative. Cerebral CT scan was normal. No other localization was found. The child was successfully treated by amphotericin B (initially with 5-fluorocytosin). Fluconazole was continued orally later on. This case is noteworthy by the absence of other localization, the favourable evolution and its occurrence in childhood. The therapeutic attitude and prevention are discussed.

Topics: Abdominal Neoplasms; Adolescent; Amphotericin B; Antineoplastic Combined Chemotherapy Protocols; Candidiasis; Fluconazole; Follow-Up Studies; Humans; Immunosuppression Therapy; Lymphoma, B-Cell; Male; Meningitis; Neoplasm Recurrence, Local