[Development of Lomentospora prolificans infection during induction therapy with venetoclax and azacitidine for acute myeloid leukemia].

Wakana Takahashi, Tatsuya Hatada, Chizuru Saito, Ryoichi Murata, Mikio Ueda, Toshihiro Miyamoto
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Abstract

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.

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[在使用 Venetoclax 和阿扎胞苷诱导治疗急性髓性白血病期间出现 Lomentospora prolificans 感染]。
Lomentospora prolificans是一种罕见的丝状真菌,会导致免疫功能低下的血液恶性肿瘤患者以及造血细胞或实体器官移植受者患上侵袭性真菌病(IFD)。一名 75 岁的妇女被诊断为急性髓性白血病,并开始接受阿扎胞苷和调整剂量的韦尼替克的诱导治疗,同时使用氟康唑进行抗真菌预防。第 7 天,她开始发热,胸部 CT 显示双肺多发结节,血清半乳甘露聚糖抗原指数呈阳性,提示可能存在 IFD。随即开始使用两性霉素 B 脂质体进行抗真菌治疗,但患者病情迅速恶化,于第 15 天死亡。后来,在她发热期间反复进行的血液培养检测中发现了增殖真菌。多发性肺结核通常对大多数抗真菌药物具有抗药性,这可能导致死亡。由于早期明确诊断比较困难,因此在常规抗真菌治疗似乎不充分的情况下,可以考虑联合治疗。
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