Fulminant <i>Clostridioides difficile</i> infection during treatment with FLT3 inhibitor for acute myeloid leukemia

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  • YAMAMOTO Jotaro
    Department of Hematology, Toranomon Hospital
  • WATANABE Otoya
    Department of Hematology, Toranomon Hospital
  • SAKO Takashi
    Department of Infectious Disease, Toranomon Hospital
  • TAKAGI Shinsuke
    Department of Hematology, Toranomon Hospital Center for Long-Term Follow-Up After Hematopoietic Cell Transplantation, Toranomon Hospital Okinaka Memorial Institute for Medical Research
  • KAJI Daisuke
    Department of Hematology, Toranomon Hospital Department of Transfusion Medicine, Toranomon Hospital
  • TAYA Yuki
    Department of Hematology, Toranomon Hospital Department of Transfusion Medicine, Toranomon Hospital
  • NISHIDA Aya
    Department of Hematology, Toranomon Hospital
  • YAMAMOTO Hisashi
    Department of Hematology, Toranomon Hospital Center for Long-Term Follow-Up After Hematopoietic Cell Transplantation, Toranomon Hospital
  • ASANO-MORI Yuki
    Center for Long-Term Follow-Up After Hematopoietic Cell Transplantation, Toranomon Hospital Department of Transfusion Medicine, Toranomon Hospital
  • YAMAMOTO Go
    Department of Hematology, Toranomon Hospital
  • ARAOKA Hideki
    Department of Infectious Disease, Toranomon Hospital Okinaka Memorial Institute for Medical Research
  • UCHIDA Naoyuki
    Department of Hematology, Toranomon Hospital Okinaka Memorial Institute for Medical Research

Bibliographic Information

Other Title
  • 急性骨髄性白血病に対するFLT3阻害薬治療中に発症した劇症型<i>Clostridioides difficile</i>感染症
  • 急性骨髄性白血病に対するFLT3阻害薬治療中に発症した劇症型Clostridioides difficile感染症 : 第18回日本血液学会関東甲信越地方会 優秀演題
  • キュウセイ コツズイセイ ハッケツビョウ ニ タイスル FLT3 ソガイヤク チリョウ チュウ ニ ハッショウ シタ ゲキショウガタ Clostridioides difficile カンセンショウ : ダイ18カイ ニホン ケツエキ ガッカイ カントウ コウシンエツチホウカイ ユウシュウ エンダイ

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Abstract

<p>An 80-year-old man with FLT3-TKD mutation-positive acute myeloid leukemia (AML) relapsed during consolidation therapy with venetoclax/azacitidine and was started on gilteritinib as salvage therapy. On the day after treatment initiation, febrile neutropenia was observed, but the fever resolved promptly after initiation of antimicrobial therapy. On the fifth day after completion of antimicrobial therapy, the patient experienced fever and watery diarrhea over 10 times a day, and a diagnosis of Clostridioides difficile infection (CDI) was made based on stool examination. The patient was treated with intravenous metronidazole, but renal dysfunction, hypotension, and hypoxemia developed, and a CT scan showed pleural and intraperitoneal effusion, significant intestinal wall thickening, and intestinal dilatation. Fidaxomicin was started under general monitoring in the intensive care unit and response was achieved. The patient was discharged from the intensive care unit on the 18th day after the onset of CDI. We report this case not only due to the rarity of fulminant CDI during AML treatment, but also because it is a valuable example of effective treatment of fulminant CDI with fidaxomicin.</p>

Journal

  • Rinsho Ketsueki

    Rinsho Ketsueki 65 (3), 153-157, 2024

    The Japanese Society of Hematology

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