Interferon gamma as an immune modulating adjunct therapy for invasive mucormycosis after severe burn - A case report.
Mucormycosis
biomarkers
immunotherapy
interferon gamma adjunct therapy
severe burn injuries
Journal
Frontiers in immunology
ISSN: 1664-3224
Titre abrégé: Front Immunol
Pays: Switzerland
ID NLM: 101560960
Informations de publication
Date de publication:
2022
2022
Historique:
received:
25
02
2022
accepted:
28
07
2022
entrez:
8
9
2022
pubmed:
9
9
2022
medline:
11
9
2022
Statut:
epublish
Résumé
Mucormycosis is a deadly fungal infection that mainly affects severely immunocompromised patients. We report herein the case of a previously immunocompetent adult woman who developed invasive cutaneous mucormycosis after severe burn injuries. Interferon-gamma (IFN-γ) treatment was added after failure of conventional treatment and confirmation of a sustained profound immunodepression. The diagnosis was based on a reduced expression of HLA-DR on monocytes (mHLA-DR), NK lymphopenia and a high proportion of immature neutrophils. The immune-related alterations were longitudinally monitored using panels of immune-related biomarkers. Initiation of IFN-γ was associated with a rapid clinical improvement and a subsequent healing of mucormycosis infection, with no residual fungi at the surgical wound repair. The serial immunological assessment showed sharp improvements of immune parameters: a rapid recovery of mHLA-DR and of transcriptomic markers for T-cell proliferation. The patient survived and was later discharged from the ICU. The treatment with recombinant IFN-γ participated to the resolution of a progressively invasive mucormycosis infection, with rapid improvement in immune parameters. In the era of precision medicine in the ICU, availability of comprehensive immune monitoring tools could help guiding management of refractory infections and provide rationale for immune stimulation strategies in these high risk patients.
Sections du résumé
Background
Mucormycosis is a deadly fungal infection that mainly affects severely immunocompromised patients. We report herein the case of a previously immunocompetent adult woman who developed invasive cutaneous mucormycosis after severe burn injuries. Interferon-gamma (IFN-γ) treatment was added after failure of conventional treatment and confirmation of a sustained profound immunodepression. The diagnosis was based on a reduced expression of HLA-DR on monocytes (mHLA-DR), NK lymphopenia and a high proportion of immature neutrophils. The immune-related alterations were longitudinally monitored using panels of immune-related biomarkers.
Results
Initiation of IFN-γ was associated with a rapid clinical improvement and a subsequent healing of mucormycosis infection, with no residual fungi at the surgical wound repair. The serial immunological assessment showed sharp improvements of immune parameters: a rapid recovery of mHLA-DR and of transcriptomic markers for T-cell proliferation. The patient survived and was later discharged from the ICU.
Conclusion
The treatment with recombinant IFN-γ participated to the resolution of a progressively invasive mucormycosis infection, with rapid improvement in immune parameters. In the era of precision medicine in the ICU, availability of comprehensive immune monitoring tools could help guiding management of refractory infections and provide rationale for immune stimulation strategies in these high risk patients.
Identifiants
pubmed: 36072605
doi: 10.3389/fimmu.2022.883638
pmc: PMC9442803
doi:
Substances chimiques
HLA-DR Antigens
0
Recombinant Proteins
0
Interferon-gamma
82115-62-6
Types de publication
Case Reports
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
883638Informations de copyright
Copyright © 2022 Tawfik, Dereux, Tremblay, Boibieux, Braye, Cazauran, Rabodonirina, Cerrato, Guichard, Venet, Monneret, Payen, Lukaszewicz and Textoris.
Déclaration de conflit d'intérêts
Authors JT, EC and AG are employees of an in-vitro diagnostic company (bioMérieux) and hold shares of the company. The company they work for hold patents related to the content of this work. Authors JT, EC, AG, DT, CD, JAT, FV, GM, and ACL are part of a joint research unit co-funded by bioMérieux, Hospices Civils de Lyon and Université Claude Bernard Lyon 1. These entities hold shared patents related to the content of this work. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
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