Invasive fungal infection is a diagnostic and therapeutic emergency in immunocompromised patients. The mucorales and Aspergillus ( fumigatus, flavus ) are the main species incriminated. Our observation is intended to bring the second case report of invasive aspergillosis due to Aspergillus oryzae and highlight the therapeutic difficulties despite the contribution of new molecules.
Our patient aged 30 was followed for acute lymphoblastic leukemia; J 20 to the induction therapy appears a brutal left blindness and ophthalmoplegia. CSF analysis eliminates a blast infiltrate; two repeated cerebral MRI rely on four days make a ethmoido-sphenoid sinusitis extending quickly to the orbital apex and the left optic canal, the temporal fossa and the anterior floor of the skull base. The images are in favor of a fungal etiology and the high rate of galactomannan antigen and pathological elements make evoke an Aspergillus. An initial combination therapy with voriconazole and amphotericin B is started with negativity of the antigen, but before the extension of lesions in anterior floor of the skull base triple therapy is then decided (expert opinion) with introduction of caspofungin. This treatment is continued two weeks, pursued by a combination therapy of three weeks involving caspofungin and voriconazole; it will be continued as monotherapy and allow the continuation of consolidation and the disappearance of lesions.
Precise identification of the species and the study of antifungal susceptibility will be established by the National Reference Centre; this strain low MICs for used antifungal agents. This species was described in 1986 as manager of an invasive sinusitis in a young man with a promyelocytic leukemia, no other human cases have been reported since. This also called yeast rice species is widely used in Asian cuisine for the preparation of sake and soy sauce (not eaten by the patient).
This case illustrates the difficulties in therapeutic fungal invasive infection in immunocompromised patients and emphasizes the need for preventive measures; the initial severity of the infection, the lack of improvement under treatment despite dual therapy should require the use of specialized therapeutic advice. It is the same for the identification and study of antifungal susceptibility to assess the true prevalence of different species in this type of pathology.
Full conference title:
- RICAI 31st (2011)