Tiraje CELKAN, İnci YILDIZ, Sebuh KURUOĞLU, Mehmet Ali SARAÇLI, Şinasi Taner YILDIRAN, Alp ÖZKAN, Hilmi APAK, Şuküfe DİREN

Amfoterisin B ve kaspofunginin birlikte kullanımı ile düzelen bir mantar infeksiyonu olgusu

Çocukluk çağı akut lösemilerinde prognoz % 80’lere ulaşmıştır Ancak tedavinin yan etkileri sonucunda gelişen nötropeni, steroid kullanımı ve tedavi komplikasyonları (karaciğer yetersizliği, hemolitik üremik sendrom, böbrek yetersizliği) infeksiyon riskini bu hastalarda arttırmaktadır. Pediatrik lösemi olgularında mantar infeksiyonlarından ölüm oranının % 21 gibi yüksek oranlarda olması bu konuya dikkat çekmektedir. Mantar infeksiyonlarının tanısı ve tedavisi bu grup hastalarda çoğu zaman sorun yaratmaktadır. Akut miyeloid lösemi (AML M5) tanısı ile izlenen ve nüks ettikten sonra, 23 günlük ağır nötropeni döneminde hem hepatosplenik hem de akciğerde mantar infeksiyonu gelişen ve yaklaşık 1 yıl amfoterisin B kullanılmasına rağmen tam remisyon elde edilmeyen bir hastada, etki mekanizması farklı bir ajan olan kaspofunginin kombine kullanılması ile klinik tam yanıta ulaşılmıştır. Mantar infeksiyonlarının tedavisinde özellikle immünsüprese hastalarda kombine antifungal tedavinin bazen çözüm olabileceğini vurgulamak amacı ile olgumuz sunulmuştur.

Anahtar Kelimeler:

Amfoterisin B, Antifungal ajanlar, Lösemi, Mikozlar, İlaç tedavisi, kombinasyon

A case of fungal infection treated by combination of amphotericin B and caspofungin

The ratio of overall survival rates in childhood acute leukemia has reached to 80 %. The underlying risk factors including neutropenia and steroid medication, medical complications (e.g. liver failure, haemolytic uremic syndrome and acute renal failure) increase infectious complications in these patients. The high percentage (21 %) of death from fungal infections among lethal infections in paediatric leukemic patients illustrates the importance of fungi in this group of patients. The following report will discuss an invasive fungal infection that occurred in a child with acute myeloblastic leukaemia (AML M5), with a severe neutropenia lasting 23 days resulting hepatosplenic and lung invasion. The progress of fungal infection despite of one year antimycotic therapy by amphotericin B, and the success achieved by the addition of caspofungin, a drug with different activity mechanism, not only illustrates the inherent problems of therapy but also the need for innovative therapeutic modalities. This case was presented to show that combination therapy may be effective in fungal infections especially in immunocompromised patients.

Keywords:

Amphotericin B, Antifungal Agents, Leukemia, Mycoses, Drug Therapy, Combination,

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