What is it about?
Mucormycosis is a life threatening fungal infection with a mortality rate exceeding 50%. This case report describes a patient who was successfully treated long term with oral posaconazole. The patient's past medical history included liver transplantation which subjected the patient to long term anti-rejection therapy. This patient poorly tolerated multiple anti-rejection agents due to renal and neurologic toxicity. Anti-rejection therapy with sirolimus was continued despite contraindicated drug interaction with anti-fungal agent, posaconazole. The therapy was successful at treating this serious infection with a follow-up period of 3 years.
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Why is it important?
Sirolimus and posaconazole combination therapy has been described in the bone marrow transplant patient population. However, this is the first report of a liver transplant patient receiving concomitant therapy for mucormycosis. Clinicians can now take advantage of new posaconazole formulations with better oral absorption. These formulations include intravenous posaconazole and delayed release posaconazole tablets.
Perspectives
This publication will be useful for clinicians who need to treat mucormycosis in immunocompromised individuals who are also in danger of renal failure. It is also useful for treating mucormycosis in transplant patients who do not tolerate calcineurin inhibitors including tacrolimus and cyclosporine.
Dr Jennifer Deyo
University of North Carolina at Chapel Hill
Read the Original
This page is a summary of: Salvage Treatment of Mucormycosis Post-Liver Transplant With Posaconazole During Sirolimus Maintenance Immunosuppression, Journal of Pharmacy Practice, July 2016, SAGE Publications,
DOI: 10.1177/0897190016628702.
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