Zygomycosis refers to any
fungal infection originating from the class Zygomycetes and the order Mucorales. In immunocompromised patients, these fungi produce a relatively rapid, violently destructive, and highly fatal
infection. Treatment approaches include both aggressive antifungal
pharmacotherapy and surgical intervention. Unfortunately, even with optimal
therapy, morbidity and mortality rates remain relatively high. As failure rates are elevated with commercial antifungals, new treatment options are needed.
Posaconazole is an orally available, extended-spectrum
triazole antifungal being investigated in phase III clinical trials for the treatment and prevention of
invasive fungal infections, including
zygomycosis. We report the case of a 26-year-old Vietnamese man with a medical history of
acute lymphocytic leukemia who had undergone
consolidation chemotherapy and had neutropenic
fever when he came to the emergency department. The patient was admitted to the hospital and treated with broad-spectrum
antibiotics and
caspofungin. Two weeks into his admission, however,
abscesses in the pelvis, prostate, and musculature surrounding the hip were detected radiographically; these
abscesses eventually cultured for Mucor sp. Disseminated
zygomycosis was diagnosed.
Caspofungin was immediately discontinued, and high-dose
liposomal amphotericin B 10 mg/kg/day was begun. Over the next month,
infection spread to the right lung, left kidney, middle thoracic spine, and epidural space. As a result, oral
posaconazole 200 mg 4 times/day was added to the
liposomal amphotericin B. Significant clinical, hematologic, mycologic, and radiologic improvements were demonstrated as early as 10 days after start of
posaconazole therapy and continued through 41 days of inpatient treatment.
Liposomal amphotericin B was discontinued after 3 weeks of
posaconazole, and the patient was discharged on hospital day 92 receiving oral
posaconazole, with no major adverse events reported. Five months after discharge, the patient had no evidence of
fungal disease recurrence or progression.
Posaconazole appears to be a well-tolerated and effective
salvage treatment for
zygomycosis, including disseminated disease.