A case of successful posaconazole salvage therapy for rhinocerebral mucormycosis after failure of amphotericin B

털곰팡이증: Amphotericin B 치료 실패 후 Posaconazole로 호전된 1예

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.

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.