Fatal zygomycosis caused by <i>Mucor indicus</i> after haplo-identical stem cell transplantation

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  • KOTEDA Satoko
    Division of Hematology and Oncology, Department of Medicine, Kurume University School of Medicine
  • NOMURA Kei
    Division of Hematology and Oncology, Department of Medicine, Kurume University School of Medicine
  • HASHIGUCHI Michitoshi
    Division of Hematology and Oncology, Department of Medicine, Kurume University School of Medicine
  • KAWAGUCHI Kuniki
    Division of Hematology and Oncology, Department of Medicine, Kurume University School of Medicine
  • OKU Eijiro
    Division of Hematology and Oncology, Department of Medicine, Kurume University School of Medicine
  • OSAKI Koichi
    Division of Hematology and Oncology, Department of Medicine, Kurume University School of Medicine
  • NAKAMURA Takayuki
    Division of Hematology and Oncology, Department of Medicine, Kurume University School of Medicine
  • MOURI Fumihiko
    Division of Hematology and Oncology, Department of Medicine, Kurume University School of Medicine
  • IMAMURA Rie
    Division of Hematology and Oncology, Department of Medicine, Kurume University School of Medicine
  • SEKI Ritsuko
    Division of Hematology and Oncology, Department of Medicine, Kurume University School of Medicine
  • NAGAFUJI Koji
    Division of Hematology and Oncology, Department of Medicine, Kurume University School of Medicine
  • MAKIMURA Koichi
    Teikyo University, Institute of Medical Mycology
  • OKAMURA Takashi
    Division of Hematology and Oncology, Department of Medicine, Kurume University School of Medicine

Bibliographic Information

Other Title
  • HLA半合致移植後に発症した<i>Mucor indicus</i>による致死的接合菌症
  • 症例報告 HLA半合致移植後に発症したMucor indicusによる致死的接合菌症
  • ショウレイ ホウコク HLA ハンガッチ イショク ゴ ニ ハッショウ シタ Mucor indicus ニ ヨル チシテキ セツゴウキンショウ

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Abstract

A 62-year-old woman with acute lymphoblastic leukemia in first complete remission was treated with unrelated cord blood transplantation, but exhibited primary graft failure. She then underwent HLA-haploidentical peripheral blood stem cell transplantation from her daughter. The conditioning regimen consisted of fludarabine 30 mg/m2/day for 6 days, intravenous busulfan 3.2 mg/kg/day for 2 days, and thymoglobulin 1 mg/kg/day for 2 days. Voriconazole was administered to prevent fungal infections. The patient achieved prompt hematopoietic recovery. Fever was observed 21 days after the second transplant, followed by sigmoid colon perforation and a liver space occupying lesion (SOL). A filamentous fungus was detected in a percutaneous biopsy of the liver SOL. In spite of changing the antifungal drug from voriconazole to liposomal amphotericin B, the patient died on day 41. The fungus was identified as Mucor indicus, a type of zygomycete. Although Mucor indicus inhabits soil, an infectious disease is extremely rare, and breakthrough infection after voriconazole prophylaxis had not been reported until now. It is mandatory to consider preventive antifungal treatment for drug-resistant fungal infectious diseases in patients after neutrophilic recovery with a strongly immunocompromised state after a HLA-haploidentical transplant.

Journal

  • Rinsho Ketsueki

    Rinsho Ketsueki 54 (3), 311-315, 2013

    The Japanese Society of Hematology

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