[Cunninghamella bertholletiae-infective endocarditis complicated by tricuspid valve giant vegetation in a patient with aplastic anemia].

A 62-year-old female was presented to the hospital of the current study for pancytopenia and was diagnosed with severe aplastic anemia. She was treated with a combination therapy of antithymocyte globulin, cyclosporine A, and eltrombopag. The patient also presented with febrile neutropenia after commencement of the treatment and did not respond to the various antibiotics and antifungal agents. Echocardiography showed a giant vegetation attached to the tricuspid valve on Day 78 of the immunosuppressive therapy, and the tricuspid valve replacement was performed. The vegetation was formed by Cunninghamella bertholletiae, a mucor type, and was treated with high-dose liposomal amphotericin B (L-AMB), which was terminated after six weeks due to decreased renal function. In addition, mucormycosis was controlled by posttreatment with posaconazole (PSCZ). This is a rare case of mucormycosis that developed into a giant vegetation during the immunosuppressive therapy for aplastic anemia. It was believed to be a valuable case to consider in future mucormycosis treatment, including the success of the treatment by switching from L-AMB to PSCZ.

[Acute myeloid leukemia complicated by pneumonia and vertebral osteomyelitis during induction chemotherapy].

A 76-year-old woman was operated on for rectal cancer in 2011 without chemotherapy and was followed up in the outpatient department. Decrease in white blood cell count was observed from 2013, and she developed anemia in 2015. Bone marrow aspiration was performed, and she was diagnosed with acute myeloid leukemia with myelodysplasia-related changes (AML/MRC). First, remission induction therapy was initiated with idarubicin and cytarabine administration, but pneumonia and vertebral osteomyelitis developed during the neutropenic period. Although the progress of antibiotics aided in the improvement of the recent prognosis of vertebral osteomyelitis compared with the past, poor prognosis with high death rate was still inevitable. Then, consolidation therapy was initiated with azacitidine (AZA) administration, and treatment was carried out for vertebral osteomyelitis with several antibiotics in parallel, which together led to the successful treatment of vertebral osteomyelitis while maintaining a remission state of AML. Because AZA is known to be well-tolerated and neutropenic phase is shorter than intensive chemotherapy in general, it can be an effective treatment option for patients who need both infection control and AML treatment.