Rhinocerebral zygomycosis in a young girl undergoing allogeneic stem cell transplantation for severe aplastic anaemia

Abstract

We report on a 10-year-old girl with severe aplastic anaemia who developed rhinocerebral infection caused by Absidia corymbifera and a possible co-infection caused by Alternaria alternata. Despite prolonged neutropenia, therapy with liposomal amphotericin B and posaconazole improved the clinical condition. Subsequently, the girl underwent allogeneic haematopoietic stem cell transplantation (HSCT) for the underlying disease, but the fungal infection remained under control with the antifungal treatment. No severe side effect of the antifungal drugs was noted. Unfortunately, the girl died 5 months after HSCT due to disseminated adenovirus infection.

Safety, Tolerability, and Pharmacokinetics of Liposomal Amphotericin B in Immunocompromised Pediatric Patients

“…The efficacy of L-AMB has been reported for pediatric patients with a variety of invasive fungal infections (10,(36)(37)(38)(39)(40)(41)(42). Although this phase I-II study was not powered to determine therapeutic outcome, several observations bear note.…”

Septic Arthritis due to Absidia corymbifera in a Patient with HIV-1 Infection

“…Amphotericin B remains the treatment of choice associated with aggressive surgical debridement, although there have been some reports about the clinical efficacy of new triazoles as posaconazol in mice [12] and humans [13,14]. The lack of initial surgery could explain the absence of improvement with amphotericin B, leading to the change to the antifungal regimen.…”

Posaconazole: when and how? The clinician’s view

“…There are a number of case reports and small case series demonstrating the safety and efficacy of posaconazole in paediatric patients. 56,[66][67][68][69][70][71][72][73] The majority of these patients were immunosuppressed with haematological malignancies, 66,71 whereas there were reports with patients with uncontrolled diabetes mellitus, 67-69 CGD patients, 56,68,73 children with aplastic anaemia, 71,72 or soft tissue trauma, 70 as have been reviewed elsewhere. 74 Although the assessment of posaconazole efficacy through a systematic review of reported cases is curtailed by publication bias and heterogeneity of data, the rate of complete or partial response of IFI managed with posaconazole in a review of 23 paediatric cases was 78%.…”