tetano
Editor, Senior Moderator
J Infect Chemother
. 2022 Nov 12;S1341-321X(22)00303-8.
doi: 10.1016/j.jiac.2022.10.020. Online ahead of print.
Successful treatment of proven coronavirus disease 2019-associated pulmonary aspergillosis with liposomal amphotericin B in a patient with bronchiolitis obliterans syndrome after allogeneic hematopoietic stem cell transplantation
Yosuke Nakaya[SUP] 1 [/SUP], Yasuhiro Nakashima[SUP] 2 [/SUP], Naonori Harada[SUP] 1 [/SUP], Koichi Yamada[SUP] 3 [/SUP], Yosuke Makuuchi[SUP] 1 [/SUP], Masatomo Kuno[SUP] 1 [/SUP], Teruhito Takakuwa[SUP] 1 [/SUP], Hiroshi Okamura[SUP] 1 [/SUP], Satoru Nanno[SUP] 4 [/SUP], Mitsutaka Nishimoto[SUP] 1 [/SUP], Hideo Koh[SUP] 1 [/SUP], Yu Nakagama[SUP] 5 [/SUP], Yasutoshi Kido[SUP] 5 [/SUP], Takayuki Kanno[SUP] 6 [/SUP], Tadaki Suzuki[SUP] 6 [/SUP], Hirohisa Nakamae[SUP] 1 [/SUP], Hiroshi Kakeya[SUP] 3 [/SUP], Masayuki Hino[SUP] 1 [/SUP]
Affiliations
Abstract
Coronavirus disease 2019 (COVID-19)-associated pulmonary aspergillosis (CAPA) is being increasingly recognized as a severe complication that contributes to poor prognoses among patients with COVID-19. However, little is known regarding the clinical course of CAPA with hematological malignancies, especially after allogeneic hematopoietic stem cell transplantation (HSCT). A 29-year-old woman was diagnosed with proven CAPA with an Aspergillus fumigatus identified by cultures of bronchoalveolar lavage and lung biopsy four years after haploidentical HSCT for acute myelogenous leukemia. She had been taking oral prednisolone for bronchiolitis obliterans syndrome that developed after HSCT. Although prolonged RT-PCR positivity for SARS-CoV-2 (133 days after the onset of COVID-19) without shedding of viable virus was observed, the COVID-19 was treated with favipiravir, remdesivir, dexamethasone, and enoxaparin. However, the CAPA did not respond to combination therapy, which included triazole (voriconazole, itraconazole, posaconazole) and echinocandin (caspofungin, micafungin), even though the Aspergillus fumigatus isolate was found to be susceptible to these agents in vitro. Nevertheless, a total of 16 weeks of liposomal amphotericin B (L-AMB) therapy led to a favorable response, and the patient was discharged from the hospital on day 213. This case provided essential experience of CAPA treated with L-AMB in a recipient with chronic respiratory disease after HSCT.
Keywords: Allogeneic hematopoietic stem cell transplantation; Bronchiolitis obliterans syndrome; COVID-19-Associated pulmonary aspergillosis; Liposomal amphotericin B; SARS-CoV-2.
. 2022 Nov 12;S1341-321X(22)00303-8.
doi: 10.1016/j.jiac.2022.10.020. Online ahead of print.
Successful treatment of proven coronavirus disease 2019-associated pulmonary aspergillosis with liposomal amphotericin B in a patient with bronchiolitis obliterans syndrome after allogeneic hematopoietic stem cell transplantation
Yosuke Nakaya[SUP] 1 [/SUP], Yasuhiro Nakashima[SUP] 2 [/SUP], Naonori Harada[SUP] 1 [/SUP], Koichi Yamada[SUP] 3 [/SUP], Yosuke Makuuchi[SUP] 1 [/SUP], Masatomo Kuno[SUP] 1 [/SUP], Teruhito Takakuwa[SUP] 1 [/SUP], Hiroshi Okamura[SUP] 1 [/SUP], Satoru Nanno[SUP] 4 [/SUP], Mitsutaka Nishimoto[SUP] 1 [/SUP], Hideo Koh[SUP] 1 [/SUP], Yu Nakagama[SUP] 5 [/SUP], Yasutoshi Kido[SUP] 5 [/SUP], Takayuki Kanno[SUP] 6 [/SUP], Tadaki Suzuki[SUP] 6 [/SUP], Hirohisa Nakamae[SUP] 1 [/SUP], Hiroshi Kakeya[SUP] 3 [/SUP], Masayuki Hino[SUP] 1 [/SUP]
Affiliations
- PMID: 36379403
- PMCID: PMC9659359
- DOI: 10.1016/j.jiac.2022.10.020
Abstract
Coronavirus disease 2019 (COVID-19)-associated pulmonary aspergillosis (CAPA) is being increasingly recognized as a severe complication that contributes to poor prognoses among patients with COVID-19. However, little is known regarding the clinical course of CAPA with hematological malignancies, especially after allogeneic hematopoietic stem cell transplantation (HSCT). A 29-year-old woman was diagnosed with proven CAPA with an Aspergillus fumigatus identified by cultures of bronchoalveolar lavage and lung biopsy four years after haploidentical HSCT for acute myelogenous leukemia. She had been taking oral prednisolone for bronchiolitis obliterans syndrome that developed after HSCT. Although prolonged RT-PCR positivity for SARS-CoV-2 (133 days after the onset of COVID-19) without shedding of viable virus was observed, the COVID-19 was treated with favipiravir, remdesivir, dexamethasone, and enoxaparin. However, the CAPA did not respond to combination therapy, which included triazole (voriconazole, itraconazole, posaconazole) and echinocandin (caspofungin, micafungin), even though the Aspergillus fumigatus isolate was found to be susceptible to these agents in vitro. Nevertheless, a total of 16 weeks of liposomal amphotericin B (L-AMB) therapy led to a favorable response, and the patient was discharged from the hospital on day 213. This case provided essential experience of CAPA treated with L-AMB in a recipient with chronic respiratory disease after HSCT.
Keywords: Allogeneic hematopoietic stem cell transplantation; Bronchiolitis obliterans syndrome; COVID-19-Associated pulmonary aspergillosis; Liposomal amphotericin B; SARS-CoV-2.