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Successful Allogeneic Bone Marrow Transplantation Using Reduced Doses of Cyclophosphamide and Fludarabine Associated to Granulocyte Transfusions in a Patient With Severe Aplastic Anemia Complicated by an Invasive Aspergillosis of Sinuses and a Rhizopus Gingivitis

Ladeb, Saloua MD*; Lakhal, Amel MD*; Barhoumi, Walid MD*; Abdejlil, Nour Ben MD*; Chelli-Bouaziz, Mouna MD; Salah, Mamia Ben MD; Torjman, Lamia MD*; Kallel, Kalthoum MD§; Maammar, Mongi MD; Othman, Tarek Ben MD*

Infectious Diseases in Clinical Practice: July 2013 - Volume 21 - Issue 4 - p 260–262
doi: 10.1097/IPC.0b013e31826e7f48
Case Reports

Mucormycosis and invasive aspergillosis complicating severe aplastic anemia are aggressive infections associated to high mortality in the lack of rapid neutrophil and monocyte recovery. We report a child who had severe aplastic anemia complicated by sinusal invasive aspergillosis and by Rhizopus arrhizus, probably breakthrough gingivitis, which occurred under voriconazole. She underwent a rescue sibling bone marrow transplantation considered as the only chance for survive. Use of fludarabine-containing conditioning, granulocyte colony-stimulating factor allowed rapid engraftment. Granulocyte transfusion and use of amphotericin B–voriconazole association permitted infection control, which was favored by immune recovery.

From the *Bone Marrow Unit, Centre National de Greffe de Moelle Osseuse (CNGMO), Tunis, Tunisia; †Radiology Department, Institut M T Kassab, Ksar-Said, Tunisia; ‡Department of Otorhinolaryngology, Hôpital Charles Nicole, Tunis, Tunisia; §Department of Mycology, Hôpital La Rabta, Tunis, Tunisia and ∥Apheresis Unit, Centre National de Transfusion sanguine, Tunis, Tunisia.

Correspondence to: Saloua Ladeb, MD, Centre National de Greffe de Moelle Osseuse, rue Jebel Lakhdhar, 1006 Bab Saadoun, Tunis, Tunisia. E-mail:

The authors have no funding or conflicts of interest to disclose.

© 2013 by Lippincott Williams & Wilkins.