Reactions 1460, p26 - 13 Jul 2013

SImmunosuppressants

Disseminated Ochroconis gallopava infection: casereport

A 55-year-old man developed disseminated Ochroconisgallopava infection while receiving immunosuppressanttherapy with antithymocyte globulin, tacrolimus,mycophenolate mofetil and prednisone [routes and durationsof treatment to reactions onset not stated; not all dosagesstated]. He subsequently died.

The man, who had a history of diabetes mellitus, underwentheart transplantation in October 2009 for ischaemiccardiomyopathy. Immunosuppressant therapy consisted ofantithymocyte globulin induction therapy, followed bytacrolimus (adjusted to target trough concentrations of8–10 ng/mL), mycophenolate mofetil 1 g/day and prednisone5 mg/day. In June 2011, he was hospitalised with fever, fatigueand abdominal pain. Upon admission, he had a bodytemperature of 39°C, a hard mass on the right buttock, ascitesand inspiratory crackles in both lung bases. Laboratoryinvestigations included the following: Haemoglobin 9.8 g/dL,WBC count 13 600/mm3, total lymphocyte count 300/mm3,CD4-positive T-cell count 27/mm3, CRP 143 mg/L, ALP558 IU/L and GGT 183 IU/L. Scans revealed two abscesses inthe right frontal and left parietal regions of the brain that hadinduced cerebral oedema, pulmonary nodules, enlargedabdominal lymph nodes, a 5 × 9cm abscess in the right buttockand peritoneal infiltration. Cultures grew O. gallopava.

The man was initially treated with liposomal amphotericin B,which was later switched to voriconazole. The abscess in hisright buttock was drained. Mycophenolate mofetil wasdiscontinued, and the dosage of tacrolimus was decreased to atrough concentration of 4 ng/mL. His condition failed toimprove, and he developed coma and intracranialhypertension. He died 2 months after diagnosis of O. gallopavainfection.

Author comment: "[T]he use of novel monoclonalantibodies, i.e., anti-CD52 and anti-CD20 monoclonalantibodies, and the increased use of tacrolimus rather thancyclosporin A, may be responsible for the emergence of thisfungal infection. Our patient had received polyclonalantibodies, tacrolimus, mycophenolate mofetil and steroids,which led to severe immunodeficiency."Cardeau-Desangles I, et al. Disseminated Ochroconis gallopava infection in a hearttransplant patient. Transplant Infectious Disease 15: E115-E118, No. 3, Jun 2013.Available from: URL: http://dx.doi.org/10.1111/tid.12084 - France 803089916

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Reactions 13 Jul 2013 No. 14600114-9954/13/1460-0001/$14.95 Adis © 2013 Springer International Publishing AG. All rights reserved