Successful Treatment with Multi-Antifungal Agents Including Voriconazole for Two Cases Developing Severe Aspergillus Infection after Bone Marrow Transplantation

Abstract

We report 2 cases who were successfully treated with multi-antifungal agents including voriconazole (VCZ) for severe aspergillus infection after bone marrow transplantation (BMT). Case 1 is a 4-year-old girlwith ALL who showed a relapse after BMT. Marked elevation of, β-D-glucan and Aspergillus antigen were observed during low-dose chemotherapy despite the anti-fungal treatment with micafungin (MCFG) and amphotericinB (AMPH-B). Theaddition of VCZ resulted in prompt improvement of the infection. Case 2 is a 15-year-old boy with chronic granulomatous disease who received donor lymphocyte infusion for graft rejection. He developed aspergillus pneumonia during the treatment for acute GVHD with tacrolimus and methylprednisolone. Treatment of MCFG and VCZ resulted in the decrease of β-D-glucan within 3 months accompanied with an improvement of lung lesions. In both cases, multiantifungal agents were very effective without any severe side effects. Monitoring the hemoconcentration of VCZ was very useful for hematopoietic stem cell transplantation recipients who received various drugs that have interactions with VCZ.