Takahashi Wakana, Hatada Tatsuya, Saito Chizuru, Murata Ryoichi, Ueda Mikio, Miyamoto Toshihiro
Department of internal medicine, Keiju Kanazawa Hospital.
Department of Hematology, Faculty of Medicine, Institute of Medical, Pharmaceutical, and Health Sciences, Kanazawa University.
Rinsho Ketsueki. 2024;65(8):742-746. doi: 10.11406/rinketsu.65.742.
Lomentospora prolificans is a rare filamentous fungus that causes invasive fungal disease (IFD) in immunocompromised patients with hematological malignancies, as well as hematopoietic cell or solid organ transplant recipients. A 75-year-old woman was diagnosed with acute myeloid leukemia, and started induction therapy with azacitidine and adjusted-dose venetoclax along with antifungal prophylaxis with fluconazole. On day 7, she became febrile and chest CT imaging showed multiple nodules in both lung fields, and the serum galactomannan antigen index became positive, indicating probable IFD. Anti-fungal therapy with liposomal amphotericin B was immediately initiated; however, the patient's condition rapidly deteriorated, and she died on day 15. L. prolificans was later identified in blood culture tests that had been repeatedly performed while she had been febrile. L. prolificans is generally resistant to most antifungal agents, which can make it fatal. As early definitive diagnosis is difficult, it may be appropriate to consider combination therapy when conventional anti-IFD therapy seems inadequate.
多育裂褶菌是一种罕见的丝状真菌，可在患有血液系统恶性肿瘤的免疫功能低下患者以及造血细胞或实体器官移植受者中引起侵袭性真菌病（IFD）。一名75岁女性被诊断为急性髓系白血病，并开始使用阿扎胞苷和调整剂量的维奈克拉进行诱导治疗，同时使用氟康唑进行抗真菌预防。第7天，她出现发热，胸部CT成像显示双肺野有多个结节，血清半乳甘露聚糖抗原指数呈阳性，提示可能患有IFD。立即开始使用脂质体两性霉素B进行抗真菌治疗；然而，患者病情迅速恶化，于第15天死亡。后来在她发热期间反复进行的血培养检测中发现了多育裂褶菌。多育裂褶菌通常对大多数抗真菌药物耐药，这可能使其具有致命性。由于早期明确诊断困难，当传统的抗IFD治疗似乎不足时，考虑联合治疗可能是合适的。
