minocycline and Graft-vs-Host-Disease

Reports of cases of mycobacterial infections after SCT are rare. We report a 30-year-old female with a cutaneous infection of Mycobacterium fortuitum 30 months after allogeneic bone marrow transplantation for acute lymphoblastic leukemia. The patient was successfully treated with surgical debridement followed by oral minocycline and clarithromycin. Mycobacterial infections should be considered in SCT patients with undiagnosed refractory chronic cutaneous infection, and surgical debridement is useful for the diagnosis and treatment of such infections.

Topics: Adult; Bone Marrow Transplantation; Clarithromycin; Combined Modality Therapy; Cyclosporine; Debridement; Drug Therapy, Combination; Female; Graft vs Host Disease; Humans; Immunocompromised Host; Immunosuppressive Agents; Methotrexate; Minocycline; Mycobacterium fortuitum; Mycobacterium Infections, Nontuberculous; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Prednisolone; Remission Induction; Skin Ulcer; Tacrolimus; Transplantation Conditioning; Transplantation, Homologous

To discuss pharmacotherapy challenges encountered during treatment of a pediatric oncology patient with Burkholderia cepacia septicemia.. An 11-year-old male with a history of aplastic anemia presented to the emergency department with a 1-day history of cough and purulent nasal discharge 6 months after undergoing bone marrow transplant. Blood cultures obtained from the patient's Broviac catheter revealed gram-negative rods. Piperacillin/tazobactam and tobramycin were administered, but the patient worsened clinically, with fever and chills. B. cepacia was identified as the offending pathogen, and the therapy was changed to meropenem and ciprofloxacin, as piperacillin/ tazobactam and tobramycin are ineffective against Burkholderia spp. Intravenous trimethoprim/sulfamethoxazole, the drug of choice for Burkholderia spp. infections, was unavailable as it had been placed on national manufacturer backorder. The patient improved initially, but he later experienced recurrence of fever, and blood culture results were positive for Burkholderia spp. Infection was eradicated after removal of the central line and administration of ceftazidime and oral minocycline.. Literature reveals few cases of B. cepacia in pediatric oncology patients, and to our knowledge, no cases have been reported in bone marrow transplant patients in the US. Burkholderia spp. is highly resistant to many antibiotics, and commonly used agents for the empiric treatment of febrile neutropenia are not active against this organism. This indicates that most oncology patients who present with this infection would not receive appropriate initial treatment. In addition, antibiotic therapy may need to be modified, based on drug availability.. B. cepacia is an emerging multidrug-resistant pathogen that can produce severe infection in immunocompromised patients. It is pertinent to consider this organism in oncology patients who do not improve with standard therapy, as prompt use of correct pharmacotherapy is necessary to avoid serious morbidity as well as mortality in this population.

Topics: Anemia, Aplastic; Anti-Bacterial Agents; Bone Marrow Transplantation; Burkholderia cepacia; Burkholderia Infections; Ceftazidime; Child; Drug Therapy, Combination; Graft vs Host Disease; Humans; Male; Minocycline; Sepsis

We present a case of progressive Mycobacterium chelonae ssp. chelonae necrotizing pneumonia after hematopoietic stem cell transplantation (HSCT) in the presence of chronic graft-versus-host disease. The patient failed to respond to standard combination therapy with multiple agents and developed resistance to most drugs over the course of treatment. Tigecycline, a new glycylcycline antimicrobial agent with in vitro activity against M. chelonae, was then used with a clinical response to treatment. To our knowledge, this is the first reported case demonstrating tigecycline to have a degree of clinical effectiveness to treat refractory pulmonary infection with M. chelonae in an HSCT recipient.

Topics: Adult; Anti-Bacterial Agents; Female; Graft vs Host Disease; Hematopoietic Stem Cell Transplantation; Humans; Minocycline; Mycobacterium chelonae; Mycobacterium Infections, Nontuberculous; Pneumonia, Bacterial; Tigecycline; Transplantation, Autologous; Treatment Outcome

Topics: Administration, Cutaneous; Administration, Oral; Adult; Anti-Bacterial Agents; Antibodies; Biomarkers; Cell Adhesion Molecules; Drug Therapy, Combination; Fatal Outcome; Female; Glucocorticoids; Graft vs Host Disease; Humans; Immunocompromised Host; Kalinin; Leukemia, Myeloid, Acute; Minocycline; Pemphigoid, Benign Mucous Membrane; Recurrence