Case Report: Isavuconazole is the most recent antifungal azole available to treat invasive fungal disease (IFD) and has been approved as first line treatment for invasive aspergillosis (IA) and as alternative treatment for mucormycosis. We present two cases of IFD with isavuconazole treatment failure in acute myeloid leukemia (AML) patients with prolonged neutropenia 100 days after hematopoietic stem cell transplantation (SCT) and severe digestive graft-versus-host disease (GVHD). The first patient was diagnosed with a probable invasive aspergillosis and a TR34/L98H azole resistant Aspergillus fumigatus and the second patient was diagnosed with a mixed Aspergillus fumigatus-Rhizomucor sp co-infection.The IFD were diagnosed using a combination of fungal biomarkers, applied systematically and including the galactomannan antigen (GM) detection and fungal qPCRs, targeting both A. fumigatus and Mucorales; this strategy proved to be optimal. These cases highlight the interest of applying a close surveillance using fungal biomarkers in very immunocompromised patients under antifungal treatment. Interestingly, the fungal biomarkers were alternatively positive. Moreover, these cases also raise several questions such as for example the influence of severe digestive GVHD on isavuconazole levels.
Full conference title:
- TIMM (2019)