1. ¹Department of Pharmacy, Division of Hematology/Oncology, Northwestern Memorial Hospital, Chicago, IL, USA
2. ²Center for Health Services Research and Policy Studies, Jesse Brown VA Medical Center, Chicago, IL, USA
3. ³Department of Medicine, Division of Hematology/Oncology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
4. ⁴Department of Emergency Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
5. ⁵Department of Medicine, Division of Geriatric Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
6. ⁶Midwest Center for Health Services and Policy Research, and Medicine-Neurology Service Line, Hines VA Hospital, Hines, IL, USA
7. ⁷Department of Medicine, Division of Infectious Diseases, Stritch School of Medicine-Loyola University Chicago, Maywood, IL, USA
8. ⁸University of Texas MD Anderson Cancer Center, Houston, TX, USA
9. ⁹Department of Medicine, Division of Infectious Disease, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
10. ¹⁰Department of Pharmacy, Wake Forest University Hospital, Winston-Salem, NC, USA
11. ¹¹Department of Medcine, Division of Infectious Diseases, Stritch School of Medicine-Loyola University Chicago, Maywood, IL, USA
12. ¹²Department of Medicine, Division of Hematology/Oncology, Ohio State University Medical Center, Columbus, OH, USA
13. ¹³Department of Infectious Disease, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

Correspondence: Dr CL Bennett, Department of Medicine, Division of Hematology/Oncology, Feinberg School of Medicine, Northwestern University, Jesse Brown VA Medical Center, 333 E Huron St, Suite 277, Chicago, IL 60611, USA. E-mail: cbenne@northwestern.edu

Received 21 August 2006; Revised 4 January 2007; Accepted 8 January 2007; Published online 19 February 2007.

Abstract

Zygomycosis is increasingly reported as a cause of life-threatening fungal infections. A higher proportion of cases reported over the last decades have been in cancer patients, with or without hematopoietic stem cell transplantation (HSCT). The new anti-fungal agent voriconazole is a recently identified risk factor for developing zygomycosis. We reviewed the clinical characteristics and outcomes of a large cohort of cancer patients who developed zygomycosis after exposure to voriconazole. Health care professionals at 13 large cancer centers provided clinical information on cancer patients with zygomycosis and prior exposure to voriconazole. Criteria for inclusion were 5 days or more of voriconazole use and diagnostic confirmation with tissue or histology. Fifty-eight cases were identified among patients with hematologic malignancies, 62% including patients who underwent a HSCT procedure. Fifty-six patients received voriconazole for primary or secondary prophylaxis against fungal infection. In addition to prior exposure to voriconazole, patients also had several of the previously established risk factors for zygomycosis. Amphotericin B was the most commonly prescribed anti-fungal therapy. Overall mortality was 73%. We conclude that zygomycosis after exposure to voriconazole is a recently described entity that is frequently fatal, despite treatment with currently available anti-fungal agents and surgery.