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Failure of voriconazole to cure disseminated zygomycosis in an immunocompromised child

Ritz, Nicole ; Ammann, Roland ; Aebischer, Carmen ; Gugger, Mathias ; Jaton, Katia ; Schmid, Ralph ; Aebi, Christoph

In: European Journal of Pediatrics, 2005, vol. 164, no. 4, p. 231-235

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    Titre
    • Failure of voriconazole to cure disseminated zygomycosis in an immunocompromised child
    Auteur
    • Ritz, Nicole. Department of Paediatrics, University of Bern, Inselspital, 3010, Bern, Switzerland
    • Ammann, Roland. Department of Paediatrics, University of Bern, Inselspital, 3010, Bern, Switzerland
    • Aebischer, Carmen. Department of Paediatrics, University of Bern, Inselspital, 3010, Bern, Switzerland
    • Gugger, Mathias. Institute of Pathology, University of Bern, Inselspital, Bern, Switzerland
    • Jaton, Katia. Institute of Microbiology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
    • Schmid, Ralph. Division of General Thoracic Surgery, University of Bern, Inselspital, Bern, Switzerland
    • Aebi, Christoph. Department of Paediatrics, University of Bern, Inselspital, 3010, Bern, Switzerland
    Type de document
    • Postprint
    Langue
    • Anglais
    Publié dans
    • European Journal of Pediatrics, 2005, vol. 164, no. 4, p. 231-235. Springer-Verlag
    Autre version électronique
    Identifiant OAI-PMH
    • oai:doc.rero.ch:316816
    Summary
    Voriconazole is increasingly used as a first-line agent for empirical antifungal therapy of prolonged febrile neutropenia in paediatric cancer patients. We describe the case of a 9-year-old patient with stage IV Burkitt lymphoma, who developed pulmonary and splenic zygomycosis while receiving voriconazole for persistent febrile neutropenia. The causative agent, Absidia corymbifera, was identified by broad-range fungal PCR in a lung biopsy sample. The patient was successfully treated with a combination of partial resection of the left upper lobe and antifungal therapy with high-dose liposomal amphotericin B followed by oral itraconazole as demonstrated by resolving pulmonary infiltrates on serial high resolution CT scans. Conclusion:This case emphasises that the lack of in vitro activity of voriconazole against zygomycetes is clinically relevant. Failure of voriconazole in suspected fungal infection should be investigated for the possibility of zygomycosis. Broad-range polymerase chain reaction may be able to identify the causative organism when cultures remain sterile