Invasive aspergillosis (IA) is the most common invasive fungal infection following a hematopoietic cell transplant, with emerging cryptic species exhibiting resistance to commonly used antifungals such as azoles. These species have been increasingly found after the introduction of anti-mold prophylaxis. We report a case of a 56-year-old female with primary myelofibrosis whose allogeneic hematopoietic cell transplant was complicated by disseminated fungal infection (skin, lung) due to Aspergillus calidoustus , a cryptic specie. Treatment of Aspergillus species remains challenging as these cryptic species are usually resistant to azoles including voriconazole which is the first line of treatment of IA. Infection was successfully treated with surgical excision and combination antifungal therapy based on in vitro susceptibility and synergy testing. Therapy included isavuconazole, a drug that has been shown to be non-inferior to voriconazole in the treatment of invasive mold infections.

中文翻译：

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成功治疗同种异体造血细胞移植受者中由高抗性曲霉菌引起的侵袭性真菌感染

侵袭性曲霉病 (IA) 是造血细胞移植后最常见的侵袭性真菌感染，新出现的隐匿物种对常用抗真菌药（如唑类）具有抗性。在引入抗霉菌预防措施后，这些物种越来越多地被发现。我们报告了一例患有原发性骨髓纤维化的 56 岁女性，其同种异体造血细胞移植并发播散性真菌感染（皮肤、肺），这是由于曲霉（一种神秘的物种）引起的。曲霉属物种的治疗仍然具有挑战性，因为这些隐匿物种通常对唑类药物具有抗性，包括伏立康唑，这是 IA 的一线治疗方法。基于体外药敏和协同试验，通过手术切除和联合抗真菌治疗成功治疗了感染。