Voriconazole as a secondary prophylaxis for cryptococcal meningitis during hematopoietic stem cell transplantation.
Cryptococcal meningitis
Hematopoietic stem cell transplantation
Voriconazole
Journal
IDCases
ISSN: 2214-2509
Titre abrégé: IDCases
Pays: Netherlands
ID NLM: 101634540
Informations de publication
Date de publication:
2021
2021
Historique:
received:
21
07
2021
revised:
24
07
2021
accepted:
25
07
2021
entrez:
11
8
2021
pubmed:
12
8
2021
medline:
12
8
2021
Statut:
epublish
Résumé
Antifungal prophylaxis is crucial for successful hematopoietic stem cell transplantation (HSCT). Maintenance therapy with fluconazole (FLCZ) is generally prescribed as secondary prophylaxis in patients with human immunodeficiency virus infection and non-immunocompromised hosts. However, previous reports have revealed that FLCZ is insufficient as a secondary prophylaxis for cryptococcal infection in HSCT cases. There is no well-established evidence of effective secondary prophylaxis against cryptococcal infection in conditions of severe immunosuppression, such as in HSCT. Herein, we report a case of atypical chronic myeloid leukemia (aCML) presenting with cryptococcal meningitis. A 58-year-old man with progressive leukocytosis and headache was referred to our hospital. Bone marrow biopsy revealed aCML. Because the estimated overall survival was limited, HSCT was indicated. Furthermore, enhanced magnetic resonance imaging and lumbar puncture aided in diagnosing cryptococcal meningitis, which was treated with a combination therapy comprising liposomal amphotericin B and 5-fluorocystine for 28 days. Given the high recurrence rate of cryptococcal meningitis, voriconazole (VRCZ) dose was calculated using the trough concentration of VRCZ in the cerebrospinal fluid. Eventually, HSCT was successfully performed at an appropriate therapeutic range of VRCZ. To the best of our knowledge, there is no case report on HSCT with secondary prophylaxis against cryptococcal meningitis. Our report thus emphasizes the efficacy of VRCZ maintenance therapy as secondary prophylaxis for cryptococcal infection.
Identifiants
pubmed: 34377674
doi: 10.1016/j.idcr.2021.e01241
pii: S2214-2509(21)00197-9
pmc: PMC8329504
doi:
Types de publication
Case Reports
Langues
eng
Pagination
e01241Informations de copyright
© 2021 The Authors. Published by Elsevier Ltd.
Déclaration de conflit d'intérêts
The authors declare no conflicts of interest associated with this manuscript.
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