Case 062: Disseminated aspergillosis in patient with Hodgkin's lymphoma (Paediatric).
Summary:

13-year-old Caucasian male with Hodgkin's lymphoma received an autologous bone marrow transplant for relapsed lymphoma, approximately four months prior to starting micafungin. The patient was diagnosed with disseminated aspergillosis with histologic confirmation of infection from the lung and A. fumigatus on a hickman cathether removed from the patient's heart. The patient was started on micafungin after the mass in the patient's heart failed to improve while receiving combination therapy with AmBisome (4.6 mg/kg/day) and voriconazole for over 100 days. The patient received micafungin in combination with AmBisome intermittently for 143 days with a significant reduction in the heart mass.

Comments:

Diagnosis:
Disseminated aspergillosis confirmed histologically from lung tissue and by culture of A. fumigatus on a Hickman catheter removed from the heart. Proven diagnosis.


Response to antifungal therapy:
Combined Ambisome and voriconazoloe therapy for 100+ days did not reduce the size of the heart mass (failure). This was switched to micafungin in combination with AmBisome resulting in a significant reduction in the heart mass by 143 days (a partial response).

Outcome:
Good outcome, but no follow up . Patients with fungal endocarditis have a tendency to relapse, often months later.