RESUMEN
Despite significant advances in the management of immunosuppressed patients, invasive fungal infections remain an important life-threatening complication. In the last decade several new antifungal agents, including compounds in pre-existing classes (new generation of triazoles, polyenes in lipid formulations) and novel classes of antifungals with a unique mechanism of action (echinocandins), have been introduced in clinical practice. Ongoing and future studies will determine their exact role in the management of different mycoses. The acceleration of antifungal drug discovery offers promise for the management of these difficult to treat opportunistic infections.
Asunto(s)
Antifúngicos/uso terapéutico , Ácido Desoxicólico/análogos & derivados , Proteínas Fúngicas , Huésped Inmunocomprometido , Micosis/tratamiento farmacológico , Péptidos Cíclicos , Péptidos , Anfotericina B/química , Anfotericina B/uso terapéutico , Antibacterianos/uso terapéutico , Antifúngicos/química , Aspergilosis/tratamiento farmacológico , Candidiasis/tratamiento farmacológico , Ácido Desoxicólico/química , Ácido Desoxicólico/uso terapéutico , Combinación de Medicamentos , Equinocandinas , Humanos , Micosis/inmunología , Fosfatidilcolinas/química , Fosfatidilcolinas/uso terapéutico , Fosfatidilgliceroles/química , Fosfatidilgliceroles/uso terapéutico , Triazoles/uso terapéuticoRESUMEN
A 15-year-old girl with homozygous sickle cell anemia (HbSS) and osteosarcoma is described. Delayed clearance of methotrexate (MTX) after the second course of high-dose MTX (HDMTX) led to the development of renal and hepatic toxicities. Rescue was accomplished with high-dose leucovorin, intravenous carboxypeptidase G2, and thymidine. Although the renal and hepatic abnormalities resolved, focal tonic-clonic seizures developed, accompanied by abnormal brain imaging. Four weeks after this episode, all clinical and biochemical abnormalities resolved. Preexistent end-organ damage associated with HbSS may compromise the ability to deliver high-dose chemotherapy with curative intent in patients with malignant disease.