Rhino-Orbital-Cerebral Mucormycosis after Allogeneic Hematopoietic Stem Cell Transplantation and Isavuconazole Therapeutic Drug Monitoring during Intestinal Graft versus Host Disease

• Main Authors: Giacomo Andreani, Gianluca Fadda, Dario Gned, Matteo Dragani, Giovanni Cavallo, Valentina Monticone, Alessandro Morotti, Marco De Gobbi, Angelo Guerrasio, Antonio D'Avolio, Daniela Cilloni
• Format: Article
• Language: English
• Published: PAGEPress Publications 2019-10-01
• Series: Mediterranean Journal of Hematology and Infectious Diseases
• Subjects: Rhino-orbital-cerebral mucormycosis, Isavuconazole, Liposomal amphotericin B, Therapeutic drug monitoring, Deferasirox
• Online Access: http://mjhid.org/index.php/mjhid/article/view/4010

  A  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. A literature review of cases of rhino-orbital-cerebral and rhino-cerebral mucormycosis in allogeneic hematopoietic stem cell transplant recipients was performed.