Successful Treatment of Paecilomyces Variotii Pneumonia and Lupus Nephritis with Posaconazole-Cyclophosphamide Co-administration Without Drug Interaction-Induced Toxicity

Successful Treatment of Paecilomyces Variotii Pneumonia and Lupus Nephritis with Posaconazole-Cyclophosphamide Co-administration Without Drug Interaction-Induced Toxicity. Pechacek, J., Webb, T., Ferre, E., Schmitt, M., Dimaggio, T., Kobrin, D., Rajasimhan, S., Colton, B., Lewis, R., Andes, D., Herrera, A., Hammoud, D., Seyedmousavi, S., Hasni, S., Bolaños, J., Afzali, B., & Lionakis, M. Open Forum Infectious Diseases, 2023.
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Paecilomyces variotii is an opportunistic mold that causes pulmonary infections in immunosuppressed humans that are often treated with triazole therapy. Lupus nephritis is a major cause of progressive kidney disease in patients with systemic lupus erythematosus, often requiring cyclophosphamide-based therapies. Triazole-cyclophosphamide co-administration is challenging as triazoles increase cyclophosphamide concentrations, which can worsen cyclophosphamide toxicity. We describe herein a patient with Paecilomyces variotii pneumonia and concomitant lupus nephritis who was successfully treated with posaconazole and echinocandin-bridged interruptions to allow for cyclophosphamide therapy. This regimen was well-tolerated without cyclophosphamide toxicity and achieved improvements in both fungal pneumonia and renal function. © 2023 Published by Oxford University Press on behalf of Infectious Diseases Society of America.

@article{pechacek.etal_2023,
  title = {Successful {{Treatment}} of {{Paecilomyces}} Variotii {{Pneumonia}} and {{Lupus Nephritis}} with {{Posaconazole-Cyclophosphamide Co-administration Without Drug Interaction-Induced Toxicity}}},
  author = {Pechacek, J. and Webb, T. and Ferre, E.M.N. and Schmitt, M.M. and Dimaggio, T. and Kobrin, D. and Rajasimhan, S. and Colton, B. and Lewis, R.E. and Andes, D. and Herrera, A. and Hammoud, D. and Seyedmousavi, S. and Hasni, S. and Bola{\~n}os, J. and Afzali, B. and Lionakis, M.S.},
  year = {2023},
  journal = {Open Forum Infectious Diseases},
  volume = {10},
  number = {8},
  issn = {2328-8957},
  doi = {10.1093/ofid/ofad410},
  abstract = {Paecilomyces variotii is an opportunistic mold that causes pulmonary infections in immunosuppressed humans that are often treated with triazole therapy. Lupus nephritis is a major cause of progressive kidney disease in patients with systemic lupus erythematosus, often requiring cyclophosphamide-based therapies. Triazole-cyclophosphamide co-administration is challenging as triazoles increase cyclophosphamide concentrations, which can worsen cyclophosphamide toxicity. We describe herein a patient with Paecilomyces variotii pneumonia and concomitant lupus nephritis who was successfully treated with posaconazole and echinocandin-bridged interruptions to allow for cyclophosphamide therapy. This regimen was well-tolerated without cyclophosphamide toxicity and achieved improvements in both fungal pneumonia and renal function. {\copyright} 2023 Published by Oxford University Press on behalf of Infectious Diseases Society of America.},
  langid = {english},
  keywords = {cyclophosphamide,drug-drug interactions,lupus nephritis,Paecilomyces,posaconazole},
  file = {/Users/russelllewis/Zotero/storage/RRWF3M7Z/Pechacek et al. - 2023 - Successful Treatment of Paecilomyces variotii Pneumonia and Lupus Nephritis with Posaconazole-Cyclop.pdf}
}

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