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Table 1 Timeline of events

From: Successful outcome of disseminated mucormycosis in a 3-year-old child suffering from acute leukaemia: the role of isavuconazole? A case report

 

Clinical features

Biology results

Antimicrobial therapy

D-19

Start of chemotherapy

Neutropenia

  

D0

Febrile neutropenia

High level of CRP and PCT

Antibiotherapy introduction

Ceftriaxone 100 mg/kg/d

D3

Persistence of fever

Rising of CRP and PCT rates

Antibiotherapy switch

Tazobactam Piperacillin 400 mg/kg/d

Amikacine

D6

Persistence of fever

 

Adding antifungal therapy

Caspofungin 70 mg/m2 day 1, then 50 mg/m2/d

D10

Abnormal chest CT scan and abdominal ultra-sound

 

Antifungal combined therapy

Adding voriconazole 9 mg/kg bid day 1, then 8 mg/kg bid IV

D16

 

Negative BAL

Withdrawal Antibiotherapy and caspofungin

 

D21

 

Positive Fundoscopy

Voriconazole intravitreal injection 50 μg/ml

 

D24

Abnormal brain MRI

Initiation of TDM on D27

 

Switch antifungal therapy

Isavuconazole 70 mg every 8 h for 48 h, then 70 mg/d IV

D31

   

Isavuconazole 90 mg/d IV

D37

  

Antifungal combined therapy

Isavuconazole 90 mg bid IV

L-AmB 10 mg/kg/d

D39

Fever resolution

   

D58

   

Isavuconazole 100 mg bid p.o

D63

TPL steady state

   

M6

Regression of lesions on imagery

   

M8

Leukaemia relapse

 

Withdrawal isavuconazole

L-AmB 7 mg/kg/d

M12

Complete remission

 

Switch antifungal therapy

Isavuconazole 50 mg bid p.o

M16

Regression of lesions on imagery

   
  1. BAL bronchoalveolar lavage, bid, twice a day, CRP C-Reactive protein, d day, IV intra-venous, L-AmB liposomal amphotericin B, PCT procalcitonin, p.o per os, TDM therapeutic drug monitoring, TPL trough plasma level