Giacomo Andreani1, Gianluca Fadda2, Dario Gned3, Matteo Dragani1, Giovanni Cavallo2, Valentina Monticone2, Alessandro Morotti1, Marco De Gobbi1, Angelo Guerrasio1, Anna Maria Barbui4, Antonio D’Avolio5 and Daniela Cilloni1.
1 Department of Clinical and Biological Sciences, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy.
2 Department of Otolaringology, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy.
3 Department of Diagnostic Imaging, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy.
4 Microbiology and Virology Unit, Azienda Ospedaliera Universitaria Città della Salute e della Scienza, Turin, Italy.
5 Department of Medical Sciences, Laboratory of Clinical Pharmacology and Pharmacogenetics, University of Turin, Amedeo di Savoia Hospital, Turin, Italy.
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diagnosis of rhino-orbital-cerebral mucormycosis was made in a
59-year-old man with a secondary acute myeloid leukemia a few days
after hematopoietic stem cell transplantation. Prompt treatment with
combined antifungal therapy (liposomal amphotericin B and
isavuconazole) followed by a procedure of endoscopic sinus surgery
resulted in the resolution of the infection. Therapeutic drug
monitoring of isavuconazole was performed during the year of treatment
showing an increment of plasma concentrations in correspondence with
the improvement of intestinal GvHD, thus suggesting that in this or
similar conditions TDM for isavuconazole can be of value.
|Figure 1. MRI images showing endocranial mycotic abscess at day 41 and the result at the end of treatment with ISC, day 359.|
|Figure 2. TDM of ISC during one year of treatment showing an increment of plasma concentrations in correspondence with the improvement of intestinal GvHD (all blood samples were collected 12 hours after the last administration of the drug).|
Literature Review of Cases of Rhino-Orbital-Cerebral Mucormycosis in Allogeneic Hematopoietic Stem Cell Transplant Recipients
|Table 1. Case series of ROCM or rhino-cerebral mucormycosis (RCM) in which infection was diagnosed during or after allogeneic HSCT.|