Breakthrough Scedosporium prolificans infection while receiving voriconazole prophylaxis in an allogeneic stem cell transplant recipient

• Published in: Transplant infectious disease Vol. 9; no. 3; pp. 241 - 243
• Main Authors: Tong, S.Y.C., Peleg, A.Y., Yoong, J., Handke, R., Szer, J., Slavin, M.
• Format: Journal Article
• Language: English
• Published: Malden, USA Blackwell Publishing Inc 01.09.2007
• Subjects: Antifungal Agents - therapeutic use; antifungal prophylaxis; Drug Synergism; fungal infection; Graft vs Host Disease - immunology; Humans; Immunocompromised Host; Immunosuppression; Male; Middle Aged; Mycetoma - drug therapy; Mycetoma - immunology; Mycetoma - prevention & control; Naphthalenes - therapeutic use; Pyrimidines - therapeutic use; Scedosporium - isolation & purification; Scedosporium prolificans; Scedosporium sp; Stem Cell Transplantation; Triazoles - therapeutic use; Voriconazole; Zygomycetes
• ISSN: 1398-2273; 1399-3062
• DOI: 10.1111/j.1399-3062.2007.00203.x

: Breakthrough invasive fungal infections among patients with hematologic malignancies receiving voriconazole are being reported with increasing frequency, with zygomycete infections predominating. We report a case of disseminated Scedosporium prolificans infection in a patient receiving voriconazole prophylaxis. Despite poor in vitro activity of voriconazole for this organism, synergy studies using the checkerboard method demonstrated synergy with the combination of voriconazole and terbinafine. This regimen, in conjunction with central venous line removal and intravitreal voriconazole, contributed to the recovery of the patient. S. prolificans is a life‐threatening mold that should be considered in patients with breakthrough invasive fungal infections while on voriconazole prophylaxis.