Cresemba (isavuconazonium sulfate) / Astellas, Basilea, Pfizer, Grupo Biotoscana, Hikma, Laboratoire Riva, Asahi Kasei, Knight Therap, MedCap AB - LARVOL DELTA

Pharmacological interactions of isavuconazole. (PubMed, Rev Iberoam Micol) - "These interactions are particularly significant for azole antifungals, such as voriconazole, fluconazole, posaconazole, and itraconazole. A significant side effect common to all azoles, but not associated with isavuconazole, is the prolongation of the QTc interval, which can sometimes lead to the risk of Torsades de Pointes. These advantages make isavuconazole the preferred antifungal choice for patients on multiple medications."

Journal

Antifungal Agents' Trends of Utilization, Spending, and Prices in the US Medicaid Programs: 2009-2023. (PubMed, Antibiotics (Basel)) - "Nystatin was the most frequently utilized SFI agent, while fluconazole emerged as the most commonly prescribed agent for invasive fungal infections (IFIs)...After being introduced to the market, efinaconazole became the most expensive SFI agent over the years. Isavuconazole, the latest approved IFI medication, demonstrated sustained utilization, reimbursement, and price increases...However, this study is limited by the lack of clinical outcome data and information on off-label use. Additionally, reimbursement data may not accurately reflect actual drug prices."

Journal • Reimbursement • US reimbursement • Infectious Disease • Novel Coronavirus Disease

Severe Disseminated Histoplasmosis With Secondary Hemophagocytic Lymphohistiocytosis in a Renal Transplant Patient (ATS 2025) - "A 76 year-old female with a history of end stage renal disease secondary to lupus, status-post renal transplant in 2021, on immunosuppressive therapy with tacrolimus, mycophenolate mofetil, and prednisone presented with two months of malaise, fevers, odynophagia and right-sided cervical lymphadenopathy...Treatment with intravenous liposomal amphotericin B and intravenous Isavuconazole was initiated...She was treated with intravenous immunoglobulin, Anakinra, Ruxolitinib, and Dexamethasone with normalization of soluble IL-2. Etoposide was avoided due to concurrent risk of worsening her disseminated fungal infection...This case highlights the importance of maintaining a high index of suspicion for fungal infections, such as histoplasmosis, and HLH in transplant patients who present with nonspecific symptoms such as fever, malaise, and pancytopenia even in non-endemic regions. Treatment of histoplasmosis-related secondary HLH is challenging, balancing the need for..."

Clinical • Cervical Cancer • Cytomegalovirus Infection • Gastroenterology • Gastrointestinal Disorder • Hemophagocytic lymphohistiocytosis • Human Immunodeficiency Virus • Immunology • Infectious Disease • Inflammatory Arthritis • Lupus • Nephrology • Oncology • Pneumonia • Rare Diseases • Renal Disease • Respiratory Diseases • Septic Shock • Transplantation • IL2

Severe Pulmonary Blastomycosis Masquerading as Histoplasmosis in an Immunosuppressed Patient (ATS 2025) - "A 58-year-old male with a history of multiple myeloma on lenalidomide and bortezomib every twenty-one days presented to the emergency department (ED) with dyspnea. He reported two months of pleuritic chest pain and two weeks of left heel pain for which he was taking ibuprofen and prednisone...Despite treatment with broad spectrum antimicrobials including voriconazole, he developed ARDS requiring intubation and mechanical ventilation...The patient was initially treated with isavuconazole, but escalated to amphotericin B due to persistent fevers...The fevers remitted, and the patient was successfully extubated to complete a 1-year course of itraconazole...Although IFI with ARDS and significant mediastinal lymphadenopathy may suggest histoplasmosis, as was initially suspected in our patient, blastomycosis may appear similarly particularly in immunosuppressed patients. Clinicians must maintain a high index of suspicion especially when clinical symptoms fail to resolve."

Clinical • Acute Respiratory Distress Syndrome • Dermatology • Hematological Malignancies • Infectious Disease • Multiple Myeloma • Oncology • Pain • Pneumonia • Pulmonary Disease • Respiratory Diseases

A Rare Case of Secondary Hemophagocytic Lymphohistiocytosis Caused by Capnocytophaga Canimorsus Meningitis (ATS 2025) - "With 2/2 blood cultures positive for Capnocytophaga canimorsus, he was diagnosed with bacterial meningitis and treated with meropenem...Etoposide and dexamethasone were started with subsequent confirmation of elevated IL-2R (3988 pg/mL) and CXCL9 (6217 pg/mL)...Despite coverage with bactrim, ganciclovir, and isavuconazole, ventilation and vasopressor requirements continued to escalate...A disproportionate immune response, refractory shock, unexplained cytopenia, and organ failure unresponsive to treatment may warrant consideration of secondary HLH. Due to overlap in presentation with sepsis, intensivists are often the first to diagnose HLH and a high index of suspicion is paramount for early recognition and treatment."

Clinical • Anemia • CNS Disorders • Dyslipidemia • Hematological Disorders • Hemophagocytic lymphohistiocytosis • Hypertriglyceridemia • Immunology • Infectious Disease • Neutropenia • Oncology • Rare Diseases • Respiratory Diseases • Septic Shock • Thrombocytopenia • CXCL9 • IL2RA

Mucorales and Actinomyces Co-infection Presenting as Erosive Pulmonary Mass in a Neutropenic Patientmucorales and Actinomyces Co-infection Presenting as Erosive Pulmonary Mass in a Neutropenic Patient (ATS 2025) - "He underwent recent 1 cycle chemotherapy with venetoclax and decitabine...Of note patient was on outpatient posaconazole for fungal prophylaxis, however therapeutic levels of the drug were not achieved...However given underlying malignancy and tenuous clinical condition alongside profound thrombocytopenia, he elected a palliative approach to his overall diagnoses, and was discharged with isavuconazole and amoxicillin...The treatment of invasive Mucor infection requires both surgical debridement and anti-fungal therapy. In certain hosts such as this patient, surgical intervention is often noted to be of prohibitively high risk, which ultimately mitigates the clinician's ability to cure the infection."

Clinical • Hematological Disorders • Infectious Disease • Musculoskeletal Diseases • Oncology • Orthopedics • Pulmonary Disease • Respiratory Diseases • Septic Shock • Thrombocytopenia

Cavitary Pulmonary Lesion in a Renal Transplant Recipient: Role of Tissue Sampling in Diagnosing Mucormycosis (ATS 2025) - "Management and Outcome: The patient was treated with intravenous liposomal amphotericin B and repeat imaging revealed progression of the lesion...1E) and postoperatively, the patient was transitioned to oral isavuconazole for a planned three month course. Immunosuppression was significantly reduced, with tacrolimus levels targeted at 2-4 ng/mL and mycophenolate mofetil held... This case highlights the importance of obtaining tissue biopsy in immunosuppressed hosts presenting with pulmonary cavitary lesions. Lack of airway communication with the cavity may result in negative BAL cultures. TBNA and biopsy sampling, either using peripheral navigation technology or linear EBUS as in our case increases the likelihood of representative sampling."

Clinical • Cardiovascular • Cough • Diabetes • Dyslipidemia • Hypertension • Infectious Disease • Metabolic Disorders • Respiratory Diseases • Transplantation • Type 1 Diabetes Mellitus

Triumph Over Pulmonary Mucormycosis With Posaconazole: Not Always the MAC Infection? (ATS 2025) - "Her medical history included bronchiectasis, systemic lupus erythematosus managed with prednisone and hydroxychloroquine, and recurrent MAC infections previously treated with azithromycin, ethambutol, and rifampin with MAC disease in remission...High-dose liposomal amphotericin B is the recommended first-line treatment, with intravenous isavuconazole and posaconazole as subsequent options. This case highlights the importance of considering pulmonary mucormycosis in patients with complex lung diseases and the efficacy of targeted antifungal therapy. Continued vigilance in diagnosis and treatment can significantly improve outcomes in this vulnerable patient population."

Bronchiectasis • Cough • Fatigue • Immunology • Infectious Disease • Inflammatory Arthritis • Lupus • Pneumonia • Pulmonary Disease • Respiratory Diseases • Systemic Lupus Erythematosus

Racing Against Time: Pulmonary Mucormycosis in a Kidney Transplant Recipient Under Experimental Anti-rejection Therapy (ATS 2025) - "He had received the transplant one month prior and was started on immunosuppressive therapy, including mycophenolate, prednisone, and a humanized monoclonal antibody currently under investigation for preventing kidney transplant rejection.On examination, he was afebrile, with a blood pressure of 156/71 mmHg, oxygen saturation of 95%, respiratory rate of 17 breaths per minute, and a heart rate of 72 beats per minute. Initial laboratory results showed a white blood cell count of 9.2 K/μL (normal range 4.5-11 K/μL), and a lactic acid level of 0.8 mmol/L (normal range 0.3-2 mmol/L).Due to his immunosuppressed state, empirical treatment with vancomycin, cefepime, and metronidazole was initiated...However, a positive Beta-D-glucan (BDG) test at 127 pg/mL (reference range < 60 pg/mL) raised concern for an invasive fungal infection, leading to the initiation of liposomal amphotericin B and isavuconazole...In immunocompromised patients, the main route of infection seems to be..."

Clinical • Chronic Kidney Disease • Cough • Fatigue • Focal Segmental Glomerulosclerosis • Glomerulonephritis • Hematological Malignancies • Immunology • Infectious Disease • Leukemia • Nephrology • Oncology • Renal Disease • Respiratory Diseases • Transplant Rejection • Transplantation

A Fatal Case of Pseudomembranous Tracheobronchitis Due to Invasive Aspergillus (ATS 2025) - "Case Description A 72-year old man with a history of orthotopic heart transplant (18 months before presentation) on sirolimus and tacrolimus, presented to an outside hospital for an urticarial rash on the arms and chest along with hypotension. He was treated for possible anaphylactic shock with IM epinephrine, IV diphenhydramine and 10mg IV dexamethasone, and transferred to our hospital...Given his immunocompromised state and imaging findings concerning for fungal infection, isavuconazole was started empirically...On HD7, micafungin was transitioned to amphotericin...After discussions with the patient's family, given his poor prognosis and his strong desire to not be on prolonged life support, he was transitioned to comfort-focused care on HD14 and passed away. Discussion We present a fatal case of pseudomembranous tracheobronchial aspergillosis in a solid organ transplant recipient receiving high dose steroids who did not survive despite early diagnosis and..."

Clinical • Acute Kidney Injury • Dermatology • Hypotension • Immunology • Infectious Disease • Inflammation • Nephrology • Renal Disease • Respiratory Diseases • Solid Organ Transplantation • Urticaria

Invasive Pulmonary Aspergillosis in a Post-lung Transplant Patient Despite Antifungal Prophylaxis (ATS 2025) - "The patient was maintained on tacrolimus, prednisone, and mycophenolate mofetil as standard immunosuppression, in addition to itraconazole for fungal prophylaxis as per our center's protocol...Bronchoalveolar lavage (BAL) confirmed Aspergillus flavus, and a high galactomannan antigen level (4.9) necessitating change of antifungal prophylaxis to isavuconazonium...Early diagnosis and monitored changes to immunosuppressive therapy are essential to ensure graft survival. Effective management of both graft rejection and fungal infection led to successful outcome in our patient."

Clinical • Chronic Obstructive Pulmonary Disease • Immunology • Infectious Disease • Pulmonary Disease • Respiratory Diseases • Transplant Rejection • Transplantation

A Life-Threatening Case of Invasive Pulmonary Aspergillosis in Patient With Bruton Agammaglobulinemia (ATS 2025) - "No clinical improvement was observed and liposomal amphotericin was added to the treatment; due to gastrointestinal side effects, isavuconazole was replaced with voriconazole. Close clinical and radiological follow-up, including investigations of other organs even without specific symptoms, is essential to assess therapy effectiveness and the need for combination or salvage therapy. If treatment proves beneficial, it should be maintained for at least six months, followed by clinical and radiological re-evaluation and monitoring for side effects."

Clinical • Bronchiectasis • Cardiovascular • CNS Disorders • Cough • Immunology • Infectious Disease • Pneumonia • Primary Immunodeficiency • Pulmonary Disease • Respiratory Diseases

Fungal Foe- A Case of Invasive Pulmonary and Cutaneous Aspergillosis in Immunocompromised Patient (ATS 2025) - "Case: A 67-year-old female with a history of extensive deep venous thrombosis of the right popliteal veins, atrial fibrillation post-cardioversion on apixaban, tachycardia-induced cardiomyopathy, COPD on home oxygen, rheumatoid arthritis on prednisone, and chronic kidney disease IIIB (baseline Cr 1.6), presented from a nursing facility for hypoxia and leukocytosis, unresponsive to outpatient therapy with azithromycin, doxycycline, and increased prednisone...She was admitted for acute-on-chronic hypoxic respiratory failure secondary to multifocal pneumonia and COPD exacerbation, was started on ceftriaxone, methylprednisolone, and nebulizations...Initially treated with amphotericin B due to potential interactions of azole antifungals with amiodarone, later transitioned to oral isavuconazonium (Cresemba)...Cutaneous aspergillosis in our patient is thought to be secondary to hematogenous spread from pulmonary infection, given the late onset of presentation. Voriconazole is..."

Clinical • Atrial Fibrillation • Cardiomyopathy • Cardiovascular • Chronic Kidney Disease • Chronic Obstructive Pulmonary Disease • Cough • Hematological Disorders • Immunology • Infectious Disease • Inflammatory Arthritis • Nephrology • Novel Coronavirus Disease • Otorhinolaryngology • Pneumonia • Pulmonary Disease • Renal Disease • Respiratory Diseases • Respiratory Syncytial Virus Infections • Rheumatoid Arthritis • Rheumatology • Sinusitis • Thrombosis

Duping the Immune System: A Case of Recurrent Allergic Bronchopulmonary Aspergillosis Treated With Dupilumab (ATS 2025) - "She restarted treatment with voriconazole and then transitioned to itraconazole and finally isavuconazonium due to side effects without improvement in symptoms. This case contributes to the growing body of literature suggesting that biologics such as dupilumab can be effective in managing ABPA, particularly in patients who fail traditional therapies. The patient's rapid improvement in total IgE and Aspergillus-related IgE levels after starting dupilumab suggests its efficacy in targeting the underlying Type 2 hypersensitivity reaction driving ABPA."

Clinical • Allergic Bronchopulmonary Aspergillosis • Allergic Rhinitis • Asthma • Bronchiectasis • CNS Disorders • Cough • Cystic Fibrosis • Genetic Disorders • Immunology • Infectious Disease • Inflammation • Mental Retardation • Pneumonia • Psychiatry • Respiratory Diseases

Confusing Your "P"s: Progressive Disseminated Histoplasmosis Mistaken for Pneumocystis Pneumonia (ATS 2025) - "A 68-year-old male with renal transplant in 2018 on prednisone and tacrolimus but not on pneumocystis prophylaxis presented with a week-long history of cough, fever, dyspnea, and fatigue...He was started on empiric broad-spectrum antibiotics, later broadened to include trimethoprim-sulfamethoxazole for suspected PCP...While this result was awaited, isavuconazole was added to cover invasive pulmonary aspergillosis...False-positive reactions for galactomannan have been shown to occur at a significant rate in the context of extremely high Histoplasma Ag levels. This case from New York State with PDH adds to evidence calling into question the so-called endemic fungi map."

Cough • Fatigue • Hematological Disorders • Infectious Disease • Pneumonia • Solid Organ Transplantation

What's Eating at Your Chest? A Case of Coccidiomycosis Empyema Necessitans (ATS 2025) - "She was started on cefepime with limited clinical improvement which prompted re-evaluation of her CT scan with concern for possible chest wall involvement...Several days later Karius blood test came back positive for C. immitis and the patient was started on isavuconazole with subsequent resolution of sepsis and acute hypoxemic respiratory failure resolved...This case highlights a rare presentation of empyema necessitans due to an atypical organism. It also demonstrates the importance of revisiting the differential diagnosis when a patient's case strays from the expected clinical course."

Clinical • Cough • Fatigue • Infectious Disease • Pneumonia • Pulmonary Disease • Respiratory Diseases • Septic Shock • Tuberculosis

Emerging Pathogenicity of Purpureocillium Lilacinum: A Case of Cavitary Lung Disease (ATS 2025) - "However, isavuconazole, posaconazole, and voriconazole are considered the most effective agents with the lowest MIC. P. lilacinum can cause rare pulmonary infections with atypical symptoms and imaging findings, complicating diagnosis and treatment due to antifungal resistance. In our patient, voriconazole was effective, but further research is needed to determine optimal treatment. Increased awareness of P. lilacinum as a significant pathogen is essential for timely diagnosis and management."

Clinical • Bronchiectasis • Chronic Obstructive Pulmonary Disease • Cough • Diabetes • Dyslipidemia • Hematological Malignancies • Immunology • Infectious Disease • Metabolic Disorders • Ocular Infections • Oncology • Ophthalmology • Pneumonia • Pulmonary Disease • Respiratory Diseases • Solid Organ Transplantation

When Dust Meets the Lungs: A Case of Pulmonary Alveolar Proteinosis in a Young Patient With Exposure to Silica (ATS 2025) - "Extensive infectious and autoimmune workup revealed positive histoplasmosis antibodies and patient was started on isavuconazonium sulfate as well as Bactrim for Pneumocystis Jirovecii pneumonia prophylaxis. Treatment of silicoproteinosis is primarily supportive; while corticosteroid provides short-term clinical improvement, they have not shown long-term benefits and may increase the risk of infections. In our case, corticosteroid and whole lung lavage provided minimal clinical improvement, and ultimately the patient underwent lung transplant."

Clinical • Bronchiectasis • Cough • Fibrosis • Immunology • Infectious Disease • Interstitial Lung Disease • Pain • Pneumonia • Pulmonary Disease • Respiratory Diseases

Invasive Aspergillosis in Immunocompetent Host Mimicking Hemophagocytic Lymphohistiocytosis (ATS 2025) - "She was initiated on Voriconazole, but due to hepatotoxicity, was switched to Isavuconazole to complete a 6-week course. Disseminated fungal infections should be considered when encountering patients with hyperinflammatory syndromes and multiorgan failure. High index of suspicion is necessary for early diagnosis and prompt treatment, which can significantly improve outcomes and prevent mortality."

Acute Kidney Injury • Acute Respiratory Distress Syndrome • Chronic Obstructive Pulmonary Disease • CNS Disorders • Epilepsy • Hemophagocytic lymphohistiocytosis • Hepatology • Immunology • Infectious Disease • Nephrology • Oncology • Osteoarthritis • Pain • Pneumonia • Pulmonary Disease • Rare Diseases • Renal Disease • Respiratory Diseases • Rheumatology • Septic Shock • Systemic Inflammatory Response Syndrome

Varicella-Zoster Virus (VZV) Pneumonia: A Cannot Miss Diagnosis in an Immunocompromised Patient Presenting With a Diffuse Vesicular Rash (ATS 2025) - "This abstract is funded by: None A 44-year-old female with a past medical history of renal transplant (on mycophenolate, prednisone for immunosuppression) for Goodpasture syndrome presented for several days of abdominal pain, nausea, and vomiting...The patient was also noted to have an elevated beta-D-glucan, a later respiratory culture with pseudomonas, and a positive serum CMV PCR, and was therefore treated with isavuconazonium, meropenem, and ganciclovir, respectively...In addition, this case shows a potential way to navigate respiratory coinfections alongside VZV in an immunocompromised patient, as seen here in managing fungal, bacterial, and additional viral etiologies of coinfection. Furthermore, this case also demonstrates a situation where acyclovir and VZV IgG were successfully used to treat a patient critically ill from disseminated VZV, adding further support for IVIG as an effective adjunctive therapy to acyclovir when VZV pneumonia is complicated by ARDS."

Clinical • Acute Respiratory Distress Syndrome • Cytomegalovirus Infection • Fibrosis • Herpes Zoster • Immunology • Infectious Disease • Pain • Pneumonia • Respiratory Diseases • Varicella Zoster

Invasive Aspergillosis Laryngitis Causing a Difficult Intubation (ATS 2025) - "Limited data is available on treatment strategies given the rarity of the disease, but patients typically respond well to typical antifungals, with surgery rarely being needed.Case PresentationThe patient presented here is a 56-year-old woman with acute myeloid leukemia on chemotherapy with azacitidine and venetoclax presented to the emergency department with complaints of hoarseness of voice and dyspnea for two weeks...Arterial blood gas while on High flow nasal cannula 60 liters, 60% was significant for pH of 7.10, pCO2 of 68, and PO2 of of 76, consistent with acute hypoxemic and hypercapnic respiratory failure.The patient was placed under moderate sedation with Midazolam and Fentanyl...The biopsy cultures grew Aspergillus fumigatus, and treatment was initiated with Amphotericin B. The patient was extubated on day five of intubation and, after finishing her fourteen-day course of Amphotericin, was discharged on Isavuconazonium with infectious disease outpatient..."

Intubation • Acute Myelogenous Leukemia • Anesthesia • Dysphonia • Hematological Malignancies • Infectious Disease • Laryngeal Cancer • Leukemia • Oncology • Otorhinolaryngology • Pulmonary Disease • Rare Diseases • Respiratory Diseases

Balancing Infection and Inflammation Control: A Case of Burkholderia Multivorans Pneumonia in Chronic Granulomatous Disease (ATS 2025) - "Initial blood cultures grew Staphylococcus hominis, and the patient was treated with Ceftaroline and Isavuconazole. As the patient's condition worsened, he was admitted to the ICU, requiring vasopressor support, mechanical ventilation, and broad-spectrum antimicrobials, including Meropenem, Linezolid, and Amphotericin B. Bronchoalveolar lavage (BAL) cultures later identified Burkholderia multivorans, prompting the addition of Bactrim... This case highlights the critical importance of balancing infection management and inflammation control in CGD patients. The judicious use of corticosteroids, in combination with appropriate antimicrobial therapy, may be effective in managing refractory infections complicated by granulomatous inflammation. However, further research is essential to establish the safety and efficacy of corticosteroid use in CGD-related infections."

Clinical • Cough • Immunology • Infectious Disease • Inflammation • Pneumonia • Primary Immunodeficiency • Respiratory Diseases • CAT • IFNG

Multifocal Pneumonia in the Setting of HTLV-1 Associated Myelopathy: A Case Report (ATS 2025) - "She was diagnosed with multifocal pneumonia and started on ceftriaxone and doxycycline empirically...Due to new blurry vision, thought to be a side effect of voriconazole, she was switched to Isavuconazole and later Posaconazole...Furthermore, these patients may likely be immunocompromised in the setting of chronic steroid use, further exacerbating symptoms. The benefits of chronic steroid use need to be weighed against the increased risk of atypical pulmonary infections."

Case report • Clinical • Cardiovascular • Dermatology • Fatigue • Infectious Disease • Inflammation • Interstitial Lung Disease • Pain • Pneumonia • Pulmonary Embolism • Respiratory Diseases • Tuberculosis

A Multicenter Retrospective Study on Antifungal Prophylaxis With Echinocandins and Isavuconazole in Post-lung Transplantation (ATS 2025) - "Isavuconazole, on the other hand, better prevents Aspergillus infections, improves anastomotic healing. Given the greater airway risks posed by Aspergillus, early post-transplant prophylaxis should prioritize Aspergillus prevention, with strategies tailored to the patient's condition."

Retrospective data • Candidiasis • Infectious Disease • Transplantation

Candida Can't Do Da:Right-sided Pleural Effusion Uncovers Spontaneous Esophageal Perforation (ATS 2025) - "His hospital course was complicated by aspiration pneumonia with MSSA and E. Vulneris, treated with Bactrim...Suspecting right-sided empyema, he was started on vancomycin, cefepime, and metronidazole, showing hemodynamic improvement...Antibiotics were switched to Unasyn, and Isavuconazole was started for fungal empyema...However, his recent history of traumatic CPR, intubation, orogastric tube placement, thoracentesis, and pneumonia created multiple risk factors for an EPF, potentially explaining his subtle presentation. This case underscores that Candida empyema should be considered a critical red flag for possible esophageal perforation, especially in immunocompetent patients without typical risk factors."

Pleural effusion • Cardiovascular • Chronic Obstructive Pulmonary Disease • Coronary Artery Disease • Cough • Gastrointestinal Disorder • Hypotension • Immunology • Infectious Disease • Metabolic Disorders • Pain • Pneumonia • Pulmonary Disease • Respiratory Diseases