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CASE REPORT
 
Breakthrough Fusarium solani fungaemia in a patient with acute myeloid leukaemia receiving posaconazole prophylaxis after three days concomitant omeprazole.
Karina O' Connell1, John Kelehan1, Martin Cormican2, Michael A Petrou3, Amjad Hayat4, Deirbhile Keady1
1Department of Medical Microbiology, University College Hospital, Galway, Ireland.
2Department of Bacteriology, National University of Ireland, Galway, Ireland.
3Department of Mycology, Imperial Healthcare NHS Trust, London, UK.
4Department of Haematology, University College Hospital, Galway, Ireland.

doi:10.5348/ijcri-2011-05-32-CR-2

Address correspondence to:
Dr. Karina O' Connell
Department of Medical Microbiology
University College Hospital
Galway
Ireland
Phone: 35391544573
Email: karinaoconnell@gmail.com

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How to cite this article:
Connell KO, Kelehan J, Cormican M, Petrou MA, Hayat A, Keady D. Breakthrough Fusarium solani fungaemia in a patient with acute myeloid leukaemia receiving posaconazole prophylaxis after three days concomitant omeprazole. International Journal of Case Reports and Images 2011;2(5):7-12.


Abstract
Introduction: Disseminated Fusarium infection carries a very high mortality therefore prevention remains the cornerstone in management of at risk patients. This approach incorporates the use of an appropriate broad spectrum antifungal agent with activity against both yeast and filamentous fungi. We report a case of breakthrough Fusarium solani infection in a 66-year-old neutropaenic female patient with acute myeloid leukaemia while on posaconazole prophylaxis.
Case Report: The patient was admitted with partial opacification of her maxillary sinuses and we believe that this served as the likely focus of infection. The fungus was isolated from blood 17 days post posaconazole prophylaxis and three days post omeprazole treatment though the Minimum Inhibitory Concentration (MIC) to posaconazole using the Clinical and Laboratory Standards Institute (CLSI) recommended method was very low. Three weeks treatment with liposomal amphotericin B proved to be successful, however, due to a rising creatinine the patient was subsequently changed to voriconazole with mycological and clinical cure.
Conclusion: This case highlights the need for full histopathological and microbiological/ mycological investigations in patients with sinus opacification or mucosal thickening, alertness to Gram stain interpretation from blood cultures and above all, awareness that when proton pump inhibitors are used they might reduce triazole absorption.

Key Words: Breakthrough, Fusarium, Posaconazole, Omeprazole, Fungaemia, Sinusitis

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Author Contributions:
Karina O' Connell - Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
John Kelehan - Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Martin Cormican - Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Michael A Petrou - Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Amjad Hayat - Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Deirbhile Keady - Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Panos Prassopoulos - Analysis and interpretation of data, Critical revision of the article, Final approval of the version to be published
Guarantor of submission:
The corresponding author is the guarantor of submission.
Source of support:
None
Conflict of interest:
The author(s) declare no conflict of interests
Copyright:
© Karina O' Connell et. al. 2011; This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any means provided the original authors and original publisher are properly credited. (Please see Copyright Policy for more information.)