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Published on: April 2, 2021

Cryptococcal fungemia in a neutropenic patient with AIDS while receiving caspofungin

Prashant Malhotra1, Sanjiv S Shah, Mark Kaplan

  • 1North Shore University Hospital, Manhasset, NY 11030, USA.

The Journal of Infection
|October 19, 2005
PubMed

Insights

Empiric antifungal therapy for febrile neutropenia requires assessing patient susceptibility to fungal pathogens. A patient with HIV, Hodgkin

Area of Science:

  • Mycology
  • Infectious Diseases
  • Hematology Oncology

Background:

  • Febrile neutropenia necessitates prompt empiric antifungal treatment.
  • Treatment selection should consider host susceptibility to endemic fungi.
  • Risk factors for invasive fungal infections include neutropenia, corticosteroid use, and immunosuppression.

Observation:

  • A patient with Human Immunodeficiency Virus (HIV) infection, Hodgkin's disease, and chemotherapy-induced neutropenia was treated with caspofungin.
  • The patient developed disseminated cryptococcal infection despite caspofungin therapy.

Findings:

  • Caspofungin, an echinocandin antifungal, was ineffective against disseminated cryptococcal infection in this immunocompromised patient.
  • This case highlights a potential limitation of echinocandins against certain fungal pathogens in high-risk individuals.

Implications:

  • Antifungal stewardship is crucial in managing febrile neutropenia.
  • Empiric antifungal selection should be guided by local epidemiology and host-specific risk factors.
  • Further research is needed to optimize antifungal strategies for complex cases of invasive fungal infections.

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