First therapy with voriconazole in a Fusarium peritonitis after renal transplantation

J. Garbino, I. Uçkay, P. Rohner, D. Lew, C. Van Delden

Abstract: 

Background: Fusarial infection in solid organ transplant (SOT) recipients is often localized, occurs later in the post-transplantation period, and has a better outcome than fusarial infection in patients with haematology malignancies or bone marrow transplants.
Methods: We present the case of an intra-abdominal infection caused by Fusarium sp. after renal transplantation.Results: A 56-year old Caucasian woman, with a medical history of type 2 diabetes and a renal failure. The patient underwent hemodialysis, which was well tolerated until the 29th month. At this time, the hemodialysis fluid became turbid. A broad spectrum empirical antibiotic treatment was started. A related cadaver kidney donor became available the following day, and a renal transplant was performed. Seven days after transplantation she developed a peritonitis. Peritoneal fluid specimens revealed the presence of filamentous fungi identified as Fusarium sp, without any other concomitant microorganisms. The sensitivity tests showed a Fusarium resistance to amphotericin B, fluconazole, flucytosine and itraconazole but sensitivity to voriconazole. A treatment with voriconazole was started for two weeks iv and then it was switched to oral voriconazole (400mg/day) for one month. The patient had a good clinical and microbiological response without recurrence of the infection. No other surgical procedures were needed beside a surgical drainage. No adverse effects were observed during the treatment period, neither drug-drug interactions. To our knowledge this is the first case reported in the literature of a Fusarium peritonitis in a SOT recipient successfully treated with voriconazole. Conclusions: Early recognition of Fusarium infection, appropriate antifungal treatment and reduction of immunosuppression (when possible), in combination with surgical procedures, are essential to reduce morbidity and mortality rates.

2004

Full conference title: 

Réunion Interdisciplinaire de Chimiothérapie Anti-Infectieuse
    • RICAI 24th (2004)