micafungin and Pneumonia--Aspiration

Topics: Abscess; Adult; Antifungal Agents; beta-Glucans; Brain Abscess; Central Nervous System Infections; Dexamethasone; Fresh Water; Humans; Invasive Fungal Infections; Lung Abscess; Magnetic Resonance Imaging; Male; Micafungin; Near Drowning; Pneumonia, Aspiration; Scedosporium; Spinal Cord Diseases; Tomography, X-Ray Computed; Voriconazole

Invasive fungal infection (IFI) caused by Lecythophora mutabilis occasionally occurs in patients with impaired host immunity; such patients had eosinophilia at onset, and surviving patients were treated with fungal cell-membrane-targeted drugs. An 18-year-old man with mitochondrial encephalomyopathy accompanied with refractory anaemia and chronic renal failure developed septic shock caused by L. mutabilis, which was detected from a blood culture, and was identified morphologically and genetically. During the course of the infection, he had eosinophilia, although beta-d-glucan levels were within the normal range. He was treated with micafungin, but deteriorated and died, despite his treatment being changed to liposomal amphotericin B. On the basis of this we suggest that IFI caused by L. mutabilis should be suspected when a compromised host develops infection and eosinophilia, and that antifungal drugs that target beta-d-glucan are not advisable.

Topics: Adolescent; Amphotericin B; Antifungal Agents; Ascomycota; Echinocandins; Humans; Insomnia, Fatal Familial; Lipopeptides; Male; Micafungin; Mitochondrial Encephalomyopathies; Mycoses; Pneumonia, Aspiration; Shock, Septic