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Vertebral infection with Candida albicans failing caspofungin and fluconazole combination therapy but successfully treated with high dose liposomal amphotericin B and flucytosine.

Storm L, Lausch KR, Arendrup MC, Mortensen KL, Petersen E - Med Mycol Case Rep (2014)

Bottom Line: A patient with Candida spondylitis failed two weeks of fluconazole combined with caspofungin, and the infection relapsed despite six weeks of liposomal amphotericin B followed by two months of fluconazole.Six months therapy with high dose liposomal amphotericin B combined with flucytosine effectively cured the patient.

View Article: PubMed Central - PubMed

Affiliation: Department of Infectious Diseases, Aarhus University Hospital Skejby, 100 Brendstrupgaardsvej, 8200 Aarhus N, Denmark.

ABSTRACT
A patient with Candida spondylitis failed two weeks of fluconazole combined with caspofungin, and the infection relapsed despite six weeks of liposomal amphotericin B followed by two months of fluconazole. Six months therapy with high dose liposomal amphotericin B combined with flucytosine effectively cured the patient.

No MeSH data available.


Related in: MedlinePlus

Day 90. MRI showed vertebral infection at Th11–12 and L3–4 with no involvement of the discs or spinal cavity.
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f0005: Day 90. MRI showed vertebral infection at Th11–12 and L3–4 with no involvement of the discs or spinal cavity.

Mentions: A month later (day 77), she was admitted to Department of Infectious Diseases with lumbar back pain located over the lumbar spine and pyrexia. The CRP was 150 mg/l, and a bone scintigraphy on day 85 showed uptake around the right hip, left sacroiliac joint and lower spine. Magnetic resonance imaging (MRI) revealed vertebral infection at Th11–12 and L3–4 with no involvement of the discs or spinal cavity, and a fungal etiology was suspected (day 90) (Fig. 1). Treatment with caspofungin (70 mg as loading dose, subsequently 50 mg) and fluconazole (initially 200 mg daily due to kidney function, subsequently 400 mg daily) was initiated. PCR and culture from the biopsy (obtained one day after initiation of antifungal treatment) were negative. The back pain progressed during the next 14 days of treatment, the CRP was only declined from 100 to 60 mg/l and a new MRI showed no regression (day 106) (Fig. 2). The patient was considered to have a treatment failure, and treatment was changed to L-AMB 4 mg/kg/day. The patient slowly improved during six weeks of treatment. When discharged on day 148, she was asymptomatic and with normal CRP (<8 mg/l). She was continuously in hemodialysis (HD) three times a week, and during the following two months, 600 mg of fluconazole was administered after each HD. The serum fluconazole concentration was measured to 9 mg/L, which is considered therapeutic level.


Vertebral infection with Candida albicans failing caspofungin and fluconazole combination therapy but successfully treated with high dose liposomal amphotericin B and flucytosine.

Storm L, Lausch KR, Arendrup MC, Mortensen KL, Petersen E - Med Mycol Case Rep (2014)

Day 90. MRI showed vertebral infection at Th11–12 and L3–4 with no involvement of the discs or spinal cavity.
© Copyright Policy - CC BY-NC-ND
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4216330&req=5

f0005: Day 90. MRI showed vertebral infection at Th11–12 and L3–4 with no involvement of the discs or spinal cavity.
Mentions: A month later (day 77), she was admitted to Department of Infectious Diseases with lumbar back pain located over the lumbar spine and pyrexia. The CRP was 150 mg/l, and a bone scintigraphy on day 85 showed uptake around the right hip, left sacroiliac joint and lower spine. Magnetic resonance imaging (MRI) revealed vertebral infection at Th11–12 and L3–4 with no involvement of the discs or spinal cavity, and a fungal etiology was suspected (day 90) (Fig. 1). Treatment with caspofungin (70 mg as loading dose, subsequently 50 mg) and fluconazole (initially 200 mg daily due to kidney function, subsequently 400 mg daily) was initiated. PCR and culture from the biopsy (obtained one day after initiation of antifungal treatment) were negative. The back pain progressed during the next 14 days of treatment, the CRP was only declined from 100 to 60 mg/l and a new MRI showed no regression (day 106) (Fig. 2). The patient was considered to have a treatment failure, and treatment was changed to L-AMB 4 mg/kg/day. The patient slowly improved during six weeks of treatment. When discharged on day 148, she was asymptomatic and with normal CRP (<8 mg/l). She was continuously in hemodialysis (HD) three times a week, and during the following two months, 600 mg of fluconazole was administered after each HD. The serum fluconazole concentration was measured to 9 mg/L, which is considered therapeutic level.

Bottom Line: A patient with Candida spondylitis failed two weeks of fluconazole combined with caspofungin, and the infection relapsed despite six weeks of liposomal amphotericin B followed by two months of fluconazole.Six months therapy with high dose liposomal amphotericin B combined with flucytosine effectively cured the patient.

View Article: PubMed Central - PubMed

Affiliation: Department of Infectious Diseases, Aarhus University Hospital Skejby, 100 Brendstrupgaardsvej, 8200 Aarhus N, Denmark.

ABSTRACT
A patient with Candida spondylitis failed two weeks of fluconazole combined with caspofungin, and the infection relapsed despite six weeks of liposomal amphotericin B followed by two months of fluconazole. Six months therapy with high dose liposomal amphotericin B combined with flucytosine effectively cured the patient.

No MeSH data available.


Related in: MedlinePlus