[Remission of invasive sinusal and pulmonary aspergillosis with liposomal amphotericin B in a patient with chronic lymphatic leukemia following failure with conventional amphotericin].
Invasive aspergillosis is a severe complication in the immunocompromised patient. Despite antifungal treatment the mortality rate is higher than 90% if the immunity deficiency is not corrected. The use and dosage of conventional amphotericin B (deoxycholate-suspended formulation) is limited by its toxicity, especially nephrotoxicity. To reduce these untoward effects, amphotericin B has been formulated in liposomes. Better tolerance and lower nephrotoxicity in the liposomal formulations allow higher doses to be given safely, even in the presence of renal failure. Liposomal encapsulated amphotericin B (LAmB) is a safe and effective alternative to conventional formulations for antifungal therapy. We present a case of a 60-year-old man affected by chronic lymphocytic leukaemia. In the course of his disease and after chemotherapy treatment, he presented an invasive aspergillosis of the lung and paransal sinuses. The rhino-sinusal lesion had progressed despite surgical debridement and treatment with amphotericin B in a dosage of 50 mg per day. Moreover, renal impairment caused by conventional amphotericin was detected. Then, LAmB was started at a dose of 150 mg per day. Treatment with LAmB has resulted in clinical recovery and radiologic ressolution.
Palacio
C
C
Secció d'Hematología clínica, Hospital General de la Ciutat Sanitària, Barcelona.
Acebedo
G
G
López
A
A
Jodar
J M
JM
D000666:Amphotericin B / Q000008:administration & dosage / Q000627:therapeutic use*; D000935:Antifungal Agents / Q000627:therapeutic use; D001228:Aspergillosis / Q000150:complications / Q000188:drug therapy*; D001229:Aspergillosis, Allergic Bronchopulmonary / Q000150:complications / Q000188:drug therapy; D003840:Deoxycholic Acid / Q000627:therapeutic use; D004337:Drug Carriers; D004338:Drug Combinations; D006801:Humans; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000150:complications; D008081:Liposomes; D008297:Male; D008875:Middle Aged; D012074:Remission Induction; D012852:Sinusitis / Q000150:complications / Q000188:drug therapy* / Q000382:microbiology; D017211:Treatment Failure
D000935:Antifungal Agents; D004337:Drug Carriers; D004338:Drug Combinations; D008081:Liposomes; D003840:Deoxycholic Acid; D000666:Amphotericin B; C059765:amphotericin B, deoxycholate drug combination
Resolución de una aspergilosis invasiva sinusal y pulmonar con anfotericina B liposómica en un paciente con leucemia linfática crónica tras fracaso de la anfotericina convencional.