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Fatal Breakthrough Mucormycosis in an Acute Myelogenous Leukemia Patient while on Posaconazole Prophylaxis

Seung Hun Kang1, Hyun Seon Kim1, Myoung Nam Bae1

  • 1Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.

Infection & Chemotherapy
|April 7, 2015
PubMed

Insights

Posaconazole prophylaxis can fail, leading to fatal mucormycosis in leukemia patients. This case highlights posaconazole

Area of Science:

  • Mycology
  • Infectious Diseases
  • Hematology

Background:

  • Posaconazole is a broad-spectrum triazole antifungal.
  • It is used for prophylaxis against invasive fungal infections in neutropenic patients, particularly those with acute myelogenous leukemia (AML) or myelodysplastic syndrome (MDS).
  • Posaconazole has demonstrated superior efficacy over fluconazole and itraconazole in preventing fungal infections.

Purpose of the Study:

  • To report the first case of fatal breakthrough mucormycosis in Korea.
  • To highlight the limitations of posaconazole prophylaxis against certain fungi.

Main Methods:

  • Case report of a patient undergoing remission induction chemotherapy for AML.
  • The patient received posaconazole prophylaxis.
  • The patient developed and succumbed to mucormycosis.

Main Results:

  • A patient on posaconazole prophylaxis developed fatal mucormycosis.
  • This represents a breakthrough fungal infection despite appropriate prophylaxis.
  • The limited activity of posaconazole against Mucorales was implicated.

Conclusions:

  • Posaconazole prophylaxis may not be fully effective against all invasive fungal infections.
  • Breakthrough mucormycosis can occur even with posaconazole use.
  • Physicians should be aware of posaconazole's limitations, especially against Mucorales in high-risk patients.
Keywords:
Leukemia, Myeloid, AcuteMucormycosisPosaconazoleProphylaxis

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