RESUMO
Invasive aspergillosis in hematologic pediatric patients is an opportunistic infection that is difficult to treat, with a high mortality rate when localized in the central nervous system. We are describing a 3-year-old girl who was affected by acute lymphoblastic leukemia who developed cerebral and pulmonary aspergillosis during induction chemotherapy. The patient failed first-line voriconazole treatment because of being a CYP2C19 ultrarapid metabolizer and received effective isavuconazole therapy with no notable side effects.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Aspergillus/efeitos dos fármacos , Neuroaspergilose/tratamento farmacológico , Nitrilas/uso terapêutico , Leucemia-Linfoma Linfoblástico de Células Precursoras/tratamento farmacológico , Aspergilose Pulmonar/tratamento farmacológico , Piridinas/uso terapêutico , Triazóis/uso terapêutico , Antifúngicos/uso terapêutico , Aspergillus/isolamento & purificação , Pré-Escolar , Feminino , Humanos , Neuroaspergilose/induzido quimicamente , Neuroaspergilose/patologia , Leucemia-Linfoma Linfoblástico de Células Precursoras/patologia , Prognóstico , Aspergilose Pulmonar/induzido quimicamente , Aspergilose Pulmonar/patologiaRESUMO
We present the case of an immunocompetent 55-year-old woman, treated with corticosteroids, developing a cerebral fungal infection with autoptic ascertainment of aspergillosis and mucormycosis. This is the first report of cerebral co-infection by mucorales and aspergillus in an immunocompetent host. A possible explanation is that corticosteroids, even if taken for a short time, led to a transient lowering of immune function and contributed to negative outcome.
Assuntos
Anti-Inflamatórios/efeitos adversos , Encefalopatias/induzido quimicamente , Mucormicose/induzido quimicamente , Neuroaspergilose/induzido quimicamente , Prednisona/efeitos adversos , Corticosteroides/efeitos adversos , Coinfecção/induzido quimicamente , Dermatomiosite/tratamento farmacológico , Feminino , Humanos , Pessoa de Meia-IdadeRESUMO
A 37-year-old male was admitted with an atypical presentation of central nervous system (CNS) aspergillosis while on ibrutinib therapy for a CNS relapse of mantle cell lymphoma. This case highlights the importance of a high clinical suspicion of opportunistic infections in patients receiving small-molecule kinase inhibitors. This report includes a review of reported cases of Aspergillus infections in patients receiving ibrutinib and the shared features of these cases.
Assuntos
Linfoma de Célula do Manto/tratamento farmacológico , Neuroaspergilose/induzido quimicamente , Pirazóis/efeitos adversos , Pirimidinas/efeitos adversos , Adenina/análogos & derivados , Adulto , Humanos , Linfoma de Célula do Manto/diagnóstico por imagem , Linfoma de Célula do Manto/metabolismo , Masculino , Neuroaspergilose/diagnóstico por imagem , Neuroaspergilose/metabolismo , Piperidinas , Pirazóis/administração & dosagem , Pirimidinas/administração & dosagem , RecidivaRESUMO
Ibrutinib has revolutionized the treatment of B-cell malignancies since its approval for chronic lymphocytic leukemia. It is also used in mantle cell lymphoma, diffuse large B-cell lymphoma, Waldenstrom's macroglobulinemia, among others. It is a Bruton's tyrosine kinase inhibitor that acts on B-cell receptor signaling pathway and predisposes to various infections due to its effects on neutrophils, monocytes and T cells. We present a case of cerebral invasive aspergillosis in a patient being treated with ibrutinib for relapsed chronic lymphocytic leukemia. It was hard to associate the condition to ibrutinib versus the chronic lymphocytic leukemia. The patient was successfully treated with a combination of voriconazole and micafungin, resulting in complete recovery and no residual deficits. This highlights the importance of recognizing the rare complication in those on ibrutinib and initiating the treatment immediately with appropriate antifungal agents to improve prognosis of this potentially fatal condition.
Assuntos
Aspergillus fumigatus , Leucemia Linfocítica Crônica de Células B/tratamento farmacológico , Neuroaspergilose/induzido quimicamente , Inibidores de Proteínas Quinases/efeitos adversos , Pirazóis/efeitos adversos , Pirimidinas/efeitos adversos , Adenina/análogos & derivados , Idoso , Antifúngicos/administração & dosagem , Aspergillus fumigatus/efeitos dos fármacos , Aspergillus fumigatus/isolamento & purificação , Linfócitos B/efeitos dos fármacos , Humanos , Leucemia Linfocítica Crônica de Células B/diagnóstico por imagem , Masculino , Neuroaspergilose/diagnóstico por imagem , Neuroaspergilose/tratamento farmacológico , PiperidinasAssuntos
Encefalopatias/induzido quimicamente , Encefalopatias/microbiologia , Neuroaspergilose/induzido quimicamente , Infecções Oportunistas/induzido quimicamente , Pirazóis/efeitos adversos , Pirimidinas/efeitos adversos , Adenina/análogos & derivados , Idoso , Humanos , Leucemia Linfocítica Crônica de Células B/tratamento farmacológico , Masculino , Piperidinas , Pirazóis/uso terapêutico , Pirimidinas/uso terapêuticoRESUMO
Aspergillus species are emerging as a significant cause of pneumonia mortality in immune compromised hosts, with haematological spread being a rare and life-threatening complication. The central nervous system (CNS) as a site for extrapulmonary spread is rarer still. We report a case of CNS disseminated aspergillosis in a patient treated with corticosteroids and infliximab, an immunomodulatory agent commonly used in the treatment of inflammatory bowel disease, and review the available literature regarding this rare pathology.
Assuntos
Corticosteroides/efeitos adversos , Doença de Crohn/tratamento farmacológico , Infliximab/efeitos adversos , Neuroaspergilose/induzido quimicamente , Neuroaspergilose/diagnóstico por imagem , Corticosteroides/administração & dosagem , Doença de Crohn/diagnóstico por imagem , Quimioterapia Combinada , Feminino , Humanos , Imunossupressores/administração & dosagem , Imunossupressores/efeitos adversos , Infliximab/administração & dosagem , Pessoa de Meia-Idade , Resultado do TratamentoAssuntos
Asma/tratamento farmacológico , Glucocorticoides/efeitos adversos , Hospedeiro Imunocomprometido , Aspergilose Pulmonar Invasiva/diagnóstico , Neuroaspergilose/diagnóstico , Prednisona/efeitos adversos , Idoso , Feminino , Humanos , Aspergilose Pulmonar Invasiva/induzido quimicamente , Neuroaspergilose/induzido quimicamenteRESUMO
Invasive fungal infections remain a life threatening complication in children with hematological malignancies. The brain represents a common site of hematogenously disseminated infections from an extracranial focus. We report our experience in the diagnosis, radiological aspects and therapeutic approach of fungal brain abscesses in 2 children receiving chemotherapy for acute lymphoblastic leukemia (ALL).