털곰팡이증: Amphotericin B 치료 실패 후 Posaconazole로 호전된 1예
A case of successful posaconazole salvage therapy for rhinocerebral mucormycosis after failure of amphotericin B
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초록
혈당 조절이 불량한 58세 남자 환자가 털곰팡이증으로 진단되었다. 5주 이상의 amphotericin B 치료를 받았으나 병은 진행하여 대뇌로 침범하였다. 이후 그는 경구 posaconazole (800 mg/d 분복)을 6개월 동안 복용 중이다. Posaconazole 구제치료 시작 1주일 후, 환자는 극적인 임상적 호전을 보였고, 부작용 없이 24주째 복용 중이다. 털곰팡이증은 그의 진행이 빠르고 예후가 불량한 감염증으로 표준치료로써 AMB가 추천되었다. 저자들은 AMB 치료에 실패하였으나, posaconazole 구제치료에 성공한 비대뇌 털곰팡이증 1예를 경험하였기에 문헌고찰과 함께 보고한다.
Abstract
A 58-year-old man with uncontrolled type 2 diabetes mellitus developed rhinocerebral mucormycosis. The infection progressed to intracranial extension despite more than 5 weeks of treatment with amphotericin B. The patient then received oral posaconazole, 800 mg/d, in divided doses for 6 months. Salvage treatment with the new azole antifungal posaconazole resulted in dramatic clinical improvement as early as 1 week after the initiation of therapy. Oral posaconazole continued through 24 weeks of treatment, with marked clinical, mycological, and radiological improvements and no adverse events. Here we review the medical literature on rhinocerebral mucormycosis, which is a rapidly progressive and often fatal infection. The treatment of choice is amphotericin B, which failed in our patient. Our case report suggests that posaconazole appears to be a well tolerated and effective salvage treatment option for rhinocerebral mucormycosis, including disseminated disease.
참고문헌 (20)
- Schwartz JC, "Rhinocerebral mucormycosis. Three case reports and subject review", J Emerg Med, 3, pp.9~11 (1985)
- Gale GR, "Studies of opportunistic fungi", Am J Med Sci, 241, pp.604~612 (1961)
- Langner S, "Posaconazole in the management of refractory invasive fungal infections", Ther Clin Risk Manag, 4, pp.747~758 (2008)
- Roden MM, "Epidemiology and outcome of zygomycosis: a review of 929 reported cases", Clin Infect Dis, 41, pp.634~653 (2005)
- Greenberg RN, "Posaconazole as salvage therapy for zygomycosis", Antimicrob Agents Chemother, 50, pp.126~133 (2006)
- Radner AB, "Acute invasive, rhinocerebral zygomycosis in an otherwise healthy patient: case report and review", Clin Infect Dis, 20, pp.163~166 (1995)
- Medoff G, "Pulmonary mucormycosis", N Engl J Med, 286, pp.86~87 (1972)
- Green WH, "Mucormycosis infection of the craniofacial structure", Am J Roentgenol Radium Ther Nucl Med, 101, pp.802~806 (1967)
- Perfect JR, "Treatment of non-Aspergillus moulds in immunocompromised patients, with amphotericin B lipid complex", Clin Infect Dis, 40(Suppl 6), pp.S401~S408 (2005)
- 정희, "당뇨병에 합병된 비대뇌 모균증 1예", 대한내과학회지, 39, pp.715~721 (1990)
- 박명규, "당뇨병에 합병된 비안와형 모균증 1예", 대한내과학회지, 47, pp.569~574 (1994)
- 이광우, "당뇨성 케톤증에 합병된 비뇌 Mucor 진균증 1예", 대한내과학회지, 25, pp.91~95 (1982)
- Alastruey-Izquierdo A, "Activity of posaconazole and other antifungal agents against Mucorales strains identified by sequencing of internal transcribed spacers", Antimicrob Agents Chemother, 53, pp.1686~1689 (2009)
- Torres HA, "Posaconazole: a broad-spectrum triazole antifungal", Lancet Infect Dis, 5, pp.775~785 (2005)
- Segal BH, "Posaconazole as salvage therapy in patients with chronic granulomatous disease and invasive filamentous fungal infection", Clin Infect Dis, 40, pp.1684~1688 (2005)
- Concoran G, "Posaconazole therapy for refractory invasive zycomycosis( poster)", 10th Congress of the European Confederation of Medical Mycology, pp.17~20 (2004)
- Tarani L, "Long-term posaconazole treatment and follow-up of rhino-orbital-cerebral mucormycosis in a diabetic girl", Pediatr Diabetes, 10, pp.289~293 (2009)
- Simmons JH, "Rhinocerebral mucormycosis complicated by internal carotid artery thrombosis in a pediatric patient with type 1 diabetes mellitus: a case report and review of the literature", Pediatr Diabetes, 6, pp.234~238 (2005)
- Perkhofer S, "Posaconazole enhances the activity of amphotericin B against hyphae of zygomycetes in vitro", Antimicrob Agents Chemother, 52, pp.2636~2638 (2008)
- 전영주, "당뇨성 케톤산증에서 폐농양이 합병된 기관지모균증 1예", 결핵 및 호흡기질환, 38, pp.317~323 (1991)