Skip to Main content Skip to Navigation
Journal articles

Failure of voriconazole therapy due to acquired azole resistance in Aspergillus fumigatus in a kidney transplant recipient with chronic necrotizing aspergillosis

Abstract : Invasive aspergillosis (IA) affects the lungs and disseminates mostly in patients with neutropenia and/or patients who are receiving immunosuppressive and steroid therapies. Despite progress in the diagnosis of and therapy for IA, it is still characterized by a high mortality rate. Currently, voriconazole is considered as the standard therapy for IA. Over recent years, triazole-resistant Aspergillus fumigatus isolates have emerged in the environment due to the use of fungicidal agricultural products, with the risk of developing IA related to a resistant isolate. However, resistance may also develop in patients who are undergoing long-term triazole therapy, particularly in the setting of chronic forms of pulmonary aspergillosis. Herein we describe a kidney transplant recipient who failed to respond to voriconazole therapy due to acquired resistance secondary to the appearance of a de novo mutation (Y121F) in the cyp51A gene during chronic necrotizing pulmonary aspergillosis. The infecting isolate acquired voriconazole resistance in 8 months despite plasma concentrations within the recommended range of the drug, necessitating lobectomy in association with a new antifungal strategy consisting of liposomal amphotericin and caspofungin with a good outcome over 36 months.
Document type :
Journal articles
Complete list of metadatas

Cited literature [21 references]  Display  Hide  Download

https://hal-pasteur.archives-ouvertes.fr/pasteur-02193115
Contributor : Reine Bouyssie <>
Submitted on : Wednesday, July 24, 2019 - 11:46:48 AM
Last modification on : Wednesday, August 19, 2020 - 11:18:42 AM

Links full text

Identifiers

Collections

Citation

Benoît Pilmis, Dea Garcia-Hermoso, Alexandre Alanio, Emilie Catherinot, Anne Scemla, et al.. Failure of voriconazole therapy due to acquired azole resistance in Aspergillus fumigatus in a kidney transplant recipient with chronic necrotizing aspergillosis. American Journal of Transplantation, Wiley, 2018, 18 (9), pp.2352-2355. ⟨10.1111/ajt.14940⟩. ⟨pasteur-02193115⟩

Share

Metrics

Record views

372