Acremonium strictum pulmonary infection in a leukemic patient successfully treated with posaconazole after failure of amphotericin B

A severely neutropenic patient with chronic lymphocytic leukemia developed a diffuse bilateral pulmonary infection while receiving a therapeutic daily dosage of intravenous amphotericin B for Candida glabrata esophagitis. Computed tomography of the chest showed numerous lung nodules, ground glass areas and a pleural effusion. Biopsy of one nodule demonstrated hyaline septate hyphae. Multiple sputum cultures grew Acremonium strictum. Increasing the dose of amphotericin B and the addition of itraconazole did not resolve the infection. Change of treatment to posaconazole given orally at 200 mg four times/d resulted in progressive improvement leading finally to cure after 24 weeks of therapy. Treatment with posaconazole was clinically and biologically well tolerated. invasive infection from Acremonium strictum was usually poor; five deaths occurred among seven reported patients. Acremonium spp. display little susceptibility to antifungal agents [1]. Fluconazole and flucytosine are ineffective. Some strains are susceptible to amphotericin B and to itraconazole. Recent in vitro data suggest that newer azoles may be effective against Acremonium spp. [8]. We present a case of severe pulmonary infection in a leukemic patient. The infection developed and progressed while the patient received amphotericin B. A change of therapy to posaconazole, a new broad-spectrum triazole available as an oral solution, was successful.