[Multiple hepatosplenic abscesses: successful treatment by continuous intraportal administration of amphotericin B in a case with acute promyelocytic leukemia].
A 40-year-old female was admitted in August 1989 with a diagnosis of acute promyelocytic leukemia (AML; M3). One course of modified-DCMP regimen induced complete remission in September, but she developed spiking fever at a nadir period of WBC after induction chemotherapy. CT revealed multiple hepato-splenic abscesses presumably due to candida infection. She was treated with intravenous administration of amphotericin B (AMPH-B) and other antifungal agents. Despite the hematological remission and prolonged use of these antifungal agents, high fever persisted. A catheter was inserted into the portal vein under ultrasonic-guidance. AMPH-B was administered through the catheter: the initial dose was 3 mg/day and was soon increased to 20 mg/day. Her fever subsided in 1 week, and the sizes of liver abscesses on CT reduced markedly. Chill and hypokalemia were observed during this therapy. The catheter was removed from the portal vein after 29 days. Partial portal vein thrombosis was noted around the catheter tip. This case suggests the usefulness of intraportal administration of AMPH-B in patients with hematological malignancy developing multiple liver abscesses.
Miyazaki
H
H
Department of medicine, Fujita Health University.
Ino
T
T
Sobue
R
R
Tuzuki
M
M
Maeda
H
H
Nomura
T
T
Wakita
M
M
Hirano
M
M
D000038:Abscess / Q000188:drug therapy*; D000328:Adult; D000666:Amphotericin B / Q000008:administration & dosage*; D002404:Catheterization; D005260:Female; D006801:Humans; D015473:Leukemia, Promyelocytic, Acute / Q000150:complications / Q000188:drug therapy*; D008100:Liver Abscess / Q000188:drug therapy*; D011169:Portal Vein; D013158:Splenic Diseases / Q000188:drug therapy*
D000666:Amphotericin B