Open Access Case report

Resolution of disseminated fusariosis in a child with acute leukemia treated with combined antifungal therapy: a case report

José-Manuel Vagace1*, Cesar Sanz-Rodriguez2, Maria-Soledad Casado1, Nieves Alonso1, Manuel Garcia-Dominguez1, Francisco Garcia de la Llana3, Luis Zarallo4, Miguel Fajardo5 and Roberto Bajo1

Author Affiliations

1 Department of Hematology, Complejo Hospitalario Infanta Cristina, Badajoz, Spain

2 Department of Clinical Research, Merck Sharp & Dohme of Spain, Madrid, Spain

3 Department of Internal Medicine, Complejo Hospitalario Infanta Cristina, Badajoz, Spain

4 Department of Pediatrics, Complejo Hospitalario Infanta Cristina, Badajoz, Spain

5 Department of Microbiology, Complejo Hospitalario Infanta Cristina, Badajoz, Spain

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BMC Infectious Diseases 2007, 7:40  doi:10.1186/1471-2334-7-40

Published: 10 May 2007

Abstract

Background

Fusarium spp. is being isolated with increasing frequency as a pathogen in oncohematologic patients. Caspofungin and amphotericin B have been reported to have synergistic activity against Fusarium spp.

Case presentation

We herein report a case of disseminated fusariosis diagnosed by chest CT scan and positive blood cultures to Fusarium spp. Because the patient's clinical condition deteriorated, CRP levels increased, and blood cultures continued to yield Fusarium spp. despite liposomal amphotericin B monotherapy up to 5 mg/kg daily, treatment with caspofungin was added. Within 2 weeks of onset of combined antifungal therapy, the chest CT scan demonstrated a progressive resolution of the pulmonary lesions. Upon discontinuation of intravenous antifungals, the patient received suppressive therapy with oral voriconazole. Three months later, a chest CT scan showed no abnormalities. Twenty-five months after discontinuation of all antifungal therapy, the patient remains in complete remission of her neoplastic disease with no signs of clinical activity of the Fusarium infection.

Conclusion

This is the first description of successful treatment of disseminated fusariosis in a pediatric patient with acute lymphoblastic leukemia with caspofungin and amphotericin B followed by oral suppressive therapy with voriconazole.