Successful treatment of azole-refractory <i>Candida guilliermondii</i> fungemia with a combination therapy with micafungin and liposomal amphotericin B

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  • SAITOH Takayuki
    Department of Medicine and Clinical Science, Gunma University Graduate School of Medicine
  • MATSUSHIMA Takafumi
    Department of Medicine and Clinical Science, Gunma University Graduate School of Medicine
  • SHIMIZU Hiroyuki
    Department of Medicine and Clinical Science, Gunma University Graduate School of Medicine
  • OSAKI Yohei
    Department of Medicine and Clinical Science, Gunma University Graduate School of Medicine
  • YAMANE Arito
    Division of Blood Transfusion Service, Gunma University Hospital
  • IRISAWA Hiroyuki
    Department of Medicine and Clinical Science, Gunma University Graduate School of Medicine
  • YOKOHAMA Akihiko
    Department of Medicine and Clinical Science, Gunma University Graduate School of Medicine
  • UCHIUMI Hideki
    Department of Medicine and Clinical Science, Gunma University Graduate School of Medicine
  • HANDA Hiroshi
    School of Health Sciences, Faculty of Medicine, Gunma University
  • TSUKAMOTO Norifumi
    Department of Medicine and Clinical Science, Gunma University Graduate School of Medicine
  • KARASAWA Masamitsu
    Division of Blood Transfusion Service, Gunma University Hospital
  • NOJIMA Yoshihisa
    Department of Medicine and Clinical Science, Gunma University Graduate School of Medicine
  • MURAKAMI Hirokazu
    School of Health Sciences, Faculty of Medicine, Gunma University

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Other Title
  • Micafunginとliposomal amphotericin Bの併用療法が奏効したazole系薬剤不応性の<i>Candida guilliermondii</i>血症
  • 症例報告 Micafunginとliposomal amphotericin Bの併用療法が奏効したazole系薬剤不応性のCandida guilliermondii血症
  • ショウレイ ホウコク Micafungin ト liposomal amphotericin B ノ ヘイヨウ リョウホウ ガ ソウコウシタ azoleケイ ヤクザイ フオウセイ ノ Candida guilliermondii ケッショウ

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Abstract

Candida guilliermondii (C. guilliermondii) are uncommon, representing approximately 1% of all Candida infections, but have been reported to show a higher rate of drug-resistance and mortality rate than C. albicans. Current guidelines for treatment of non-albicans candidemia in neutropenic patients now recommend the use of amphotericin B or voriconazole (VRCZ). We describe here the successful treatment for a 58-year-old male with azole-refractory C. guilliermondii fungemia by combination with liposomal (L-AmB) and micafungin (MCFG) therapy. He was diagnosed as having mantle cell lymphoma, and treatment with HyperCVAD (Rituximab, cyclophosphamide, vincristine, doxorubicin, dexamethasone) was started. Despite prophylactic treatment with fluconazole, he developed fungemia due to C. guilliermondii 41 days after the start of chemotherapy. Positive blood culture and high levels of (1→3)-β-D-glucan persisted despite changing the treatment from fluconazole to voriconazole. Although L-AmB was also added to VRCZ, the clinical symptoms worsened. When MCFG was combined with L-AmB, the symptoms and data dramatically improved. Thus, combination therapy consisting of MCFG and L-AmB might be more effective against candidemia that is refractory to azole than combination therapy with VRCZ and L-AmB.

Journal

  • Rinsho Ketsueki

    Rinsho Ketsueki 49 (2), 94-98, 2008

    The Japanese Society of Hematology

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