Abstract
A severely neutropenic patient with chronic lymphocytic leukemia developed a diffuse bilateral pulmonary infection while receiving a therapeutic daily dosage of intravenous amphotericin B for Candida glabrata esophagitis. Computed tomography of the chest showed numerous lung nodules, ground glass areas and a pleural effusion. Biopsy of one nodule demonstrated hyaline septate hyphae. Multiple sputum cultures grew Acremonium strictum. Increasing the dose of amphotericin B and the addition of itraconazole did not resolve the infection. Change of treatment to posaconazole given orally at 200 mg four times/d resulted in progressive improvement leading finally to cure after 24 weeks of therapy. Treatment with posaconazole was clinically and biologically well tolerated.
Publication types
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Case Reports
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Research Support, Non-U.S. Gov't
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Review
MeSH terms
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Acremonium / drug effects*
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Acremonium / isolation & purification*
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Administration, Oral
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Amphotericin B / administration & dosage*
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Antifungal Agents / administration & dosage
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Biopsy, Needle
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Female
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Follow-Up Studies
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Humans
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Immunocompromised Host*
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Lung Diseases, Fungal / diagnosis*
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Lung Diseases, Fungal / drug therapy*
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Microbial Sensitivity Tests
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Middle Aged
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Precursor Cell Lymphoblastic Leukemia-Lymphoma / complications
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Precursor Cell Lymphoblastic Leukemia-Lymphoma / drug therapy
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Precursor Cell Lymphoblastic Leukemia-Lymphoma / immunology*
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Risk Assessment
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Tomography, X-Ray Computed
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Treatment Failure
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Treatment Outcome
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Triazoles / administration & dosage*
Substances
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Antifungal Agents
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Triazoles
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posaconazole
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Amphotericin B