Abstract
Background.Invasive fungal infections (IFI) contribute significantly to mortality and morbidity in patients receiving myelosuppressive chemotherapy for hematologic malignancies. Acquired gastropulmonary fistula is a rare complication of IFI.Material and methods.We present a case history of a patient with malignant myeloma. She was treated with autologous stem cell transplantation and chemotherapy for three years. She had been treated with antifungal agents as well. Following a specific treatment, she developed an invasive fungal infection (IFI) of the left lung which had been complicated with left gastropulmonary fistula. The patient’s general condition was deteriorating, so it was decided to perform a surgical intervention. At the first procedure, open-window thoracostomy was created in order to facilitate treatment by daily packing of the cavity. Four weeks after the thoracostomy, a thoracomyoplasty was performed to repair a gastropleural fistula. During the laparotomy, the gastric fundus was freed from adjacent tissues and repaired. Intrathoracic transposition of the latissimus dorsi and anterior serratus muscle flaps was performed simultaneously to create a new diaphragm. The open-window thoracostomy was left open due to some small bronchial fistulas. The thoracostomy opening healed spontaneously during the following six months.Conclusion.We report what is, to the best of our knowledge, the first case of an invasive fungal infection (Geotrichum capitatum) successfully treated with intravenous amphotericin B, voriconazole, and surgery on infected soft tissues (organs) for a patient with multiple myeloma in prolonged neutropenia. The efficacy and safety of the surgery for infected soft tissues requires further evaluation.
Highlights
Treatment of multiple myeloma generally consists of chemo-immunotherapy and autologous stem cell transplantation, with the latter prolonging disease-free survival and overall survival
She was treated with autologous stem cell transplantation and chemotherapy for three years. She had been treated with antifungal agents as well. She developed an invasive fungal infection (IFI) of the left lung which had been complicated with left gastropulmonary fistula
To the best of our knowledge, the first case of an invasive fungal infection (Geotrichum capitatum) successfully treated with intravenous amphotericin B, voriconazole, and surgery on infected soft tissues for a patient with multiple myeloma in prolonged neutropenia
Summary
Treatment of multiple myeloma generally consists of chemo-immunotherapy and autologous stem cell transplantation, with the latter prolonging disease-free survival and overall survival. Infection is a significant cause of morbidity and mortality in patients with multiple myeloma [7, 8]. The most important advances in the treatment of transplant recipients and patients with haematological neoplasm have been accompanied by an increase in the incidence of the common fungal diseases and the emergence of some less common ones. One of them is Saprochaete capitata (formerly known as Geotrichum capitatum and Blastoschizomyces capitatus). It is a non-fermentative, non-encapsulated, urease-negative ascomycetous yeast [2, 3]. Invasive fungal infections (IFI) contribute significantly to mortality and morbidity in patients receiving myelosuppressive chemotherapy for hematologic malignancies.
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