First therapy with voriconazole in a Fusarium peritonitis after renal transplantation

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


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.


Full conference title: 

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