micafungin and Graft-vs-Host-Disease

Few cases of cryptococcal infection following umbilical cord blood transplantation (UCBT) have been reported. We report a case, where cryptococcal infection occurred soon after rapidly reducing the dose of tacrolimus in a UCBT recipient who received micafungin prophylaxis during the early phase of transplantation. The etiology of cryptococcal infection following allogeneic hematopoietic stem cell transplantation (allo-HSCT), including UCBT, might be associated with rapid dose-reduction of calcineurin inhibitors, such as tacrolimus during early phase of allo-HSCT. To our knowledge, this is the first English-language report to describe in detail a case of cryptococcal meningitis with fungemia during early phase of UCBT.

Topics: Antibiotic Prophylaxis; Antifungal Agents; Calcineurin Inhibitors; Cord Blood Stem Cell Transplantation; Cryptococcus neoformans; Dose-Response Relationship, Drug; Fungemia; Graft vs Host Disease; Hematopoietic Stem Cell Transplantation; Humans; Male; Meningitis, Cryptococcal; Micafungin; Middle Aged; Tacrolimus; Transplantation, Homologous

Exophiala dermatitidis infections in patients with hematological malignancies are very rare. Our patient had a blood stream infection caused by E. dermatitidis following the second umbilical cord blood transplantation (UCBT) after graft failure during the first UCBT. To our knowledge, this is the first report describing a breakthrough fungal infection caused by E. dermatitidis during the prophylactic administration of micafungin (MCFG). Therefore, MCFG-treated patients should be monitored for breakthrough E. dermatitidis infection during hematopoietic stem cell transplantation.

Topics: Antifungal Agents; Cord Blood Stem Cell Transplantation; Echinocandins; Exophiala; Fatal Outcome; Graft vs Host Disease; Humans; Immunocompromised Host; Lipopeptides; Male; Micafungin; Middle Aged; Phaeohyphomycosis; Primary Myelofibrosis

The prophylactic use of antifungal drugs in allogeneic hematopoietic cell transplant recipients has revealed that the rate of non-albicans candidemia has increased. We herein report the case of a patient with adult T-cell leukemia who developed candidemia due to Candida fermentati during micafungin treatment after cord blood transplantation. The isolate was identified on day 47 by sequencing of the internal transcribed spacer region of the ribosomal RNA gene. The sequencing of the hot spot region of fks1p of isolate revealed naturally occurring amino acid substitutions, which conferred reduced echinocandin susceptibility. This case highlights that breakthrough candidemia due to C. fermentati occurred in a patient receiving micafungin treatment.

Topics: Aged; Antibiotic Prophylaxis; Antifungal Agents; Candida; Candidemia; Central Venous Catheters; Cord Blood Stem Cell Transplantation; DNA, Fungal; Drug Resistance, Fungal; Echinocandins; Fungal Proteins; Graft vs Host Disease; Humans; Leukemia-Lymphoma, Adult T-Cell; Lipopeptides; Male; Micafungin; Microbial Sensitivity Tests; Mutation; Sequence Analysis, DNA; Transplant Recipients; Transplantation Conditioning

A 59-year-old man was admitted to our hospital with a diagnosis of acute myeloid leukemia in September 2004. He developed invasive pulmonary aspergillosis (IPA) and candidiasis, which were improved by administration of micafungin and amphotericin B (AMPH-B). He received reduced-intensity unrelated cord-blood transplantation without induction chemotherapy. He developed grade IV graft-versus-host disease (GVHD) and the administration of steroids against GVHD was prolonged. Voriconazole (VRCZ) was used for a long period to prevent recurrence of the IPA. Afterwards, infiltrates in the bilateral upper lung fields were detected on a chest CT scan, and a diagnosis of pulmonary mucormycosis was made following detection of Mucor circinelloides from the patient's sputum culture. He then began receiving AMPH-B but died of massive hemoptysis. Mucormycosis usually occurs in immunocompromised hosts such as neutropenic patients with hematologic diseases and is a fatal fungal infection characterized by a rapid and progressive clinical course. Some overseas investigators have recently reported that VRCZ prophylaxis may result in breakthrough mucormycosis in hematopoietic stem cell transplant recipients. These findings suggest that it is very important to pay attention to mucormycosis in hematopoietic stem cell transplant recipients in this country.

Topics: Amphotericin B; Antifungal Agents; Aspergillosis; Cord Blood Stem Cell Transplantation; Echinocandins; Fatal Outcome; Graft vs Host Disease; Humans; Immunocompromised Host; Immunosuppressive Agents; Leukemia, Myeloid, Acute; Lipopeptides; Lipoproteins; Lung Diseases, Fungal; Male; Micafungin; Middle Aged; Mucormycosis; Peptides, Cyclic; Pyrimidines; Transplantation Conditioning; Triazoles; Voriconazole