Case Study: Multifungal Infection in a Patient Treated With Ibrutinib for CLL
Posted: Thursday, February 13, 2020
A case study published in Medical Mycology Case Reports described a multifungal infection resulting in accelerated clinical deterioration of a patient with chronic lymphocytic leukemia (CLL) undergoing first-line ibrutinib treatment. A high risk of fungal infection is one of the documented adverse events of ibrutinib treatment.
“This case may have therapeutic implications, as it highlights the possibility of ibrutinib-associated, simultaneous multifungal infection with a rapid clinical deterioration in the absence of conventional risk factors for invasive fungal infections,” noted Katia Boggian, MD, of Cantonal Hospital St. Gallen, Switzerland, and colleagues.
The patient was male and 71 years old; he experienced considerable weight loss, fatigue, and recently developed palpable splenomegaly and lymphadenopathy 13 months after being diagnosed with CLL. First-line treatment with obinutuzumab and ibrutinib initially resulted in a decrease in lymphadenopathy and leukocytosis and an increase in energy, as well as weight maintenance. Venetoclax was introduced 3 weeks into the treatment cycle in a ramp-up schedule. Within 72 hours of beginning venetoclax treatment, the patient reported to the emergency room with pneumonia and pleural effusion resulting in sepsis. Right-sided hemiplegia and a steady deterioration of consciousness occurred within hours of admission. A seizure followed, after which the patient entered a coma. He died 4 days after being admitted.
According to the autopsy, the cause of death was “angioinvasive fungal sepsis with fungal meningoencephalitis.” The mucorales species was found intravascularly, including Rhizomucor pusillus and Aspergillus fumigatus. Notably, the patient was found to be in complete remission from CLL.
“To the best of our knowledge, this is the first report of an invasive multifungal infection confirmed by histology and [polymerase chain reaction] in a patient treated with ibrutinib,” stated the authors.
Disclosure: The study authors reported no conflicts of interest.