[Multiple candida liver abscesses successfully treated by continuous intrahepatic arterial infusion of amphotericin B using a reservoir in a case with acute myelocytic leukemia (M2)].
A 49-year-old male was admitted with a diagnosis of AML (M2). One course of BHAC-DM regimen induced complete remission. During the consolidation therapy, he developed marked pyrexia resistent to antibiotics. Ultrasonography and CT scan revealed multiple small liver abscesses, which suggested mycotic etiology. After unsuccessful treatment with intravenous administration of fluconazole, a percutaneous transhepatic intraportal administration of Amphotericin B (AMPH-B) (20 mg/day) was started, followed by the consolidation chemotherapy. When the first positive blood culture was obtained for Candida, a reservoir was embedded in the subcutaneous layer of the right iliac region and the intrahepatic arterial administration of AMPH-B (5 to 20 mg/day) by the Infusor (Baxter Healthcare Corporation), a portable, disposable drug delivery system that provides a constant drug flow, was started. The liver abscesses has almost disappeared when the maintenance chemotherapy was completed. The side effects of AMPH-B were negligible. This case suggests the usefulness of the intrahepatic arterial infusion of AMPH-B using an inplantable drug delivery system in patients with hematological malignancies developing intractable multiple fungal liver abscesses.
Department of Internal Medicine, Chugoku Central Hospital of the Mutual Aid Association of Public School Teachers, Fukuyama City.
A
A
Miyata
K
K
Honda
M
M
Fujita
T
T
Kikuchi
D000666:Amphotericin B / Q000008:administration & dosage*; D000935:Antifungal Agents / Q000008:administration & dosage*; D002177:Candidiasis / Q000188:drug therapy* / Q000209:etiology; D004209:Disposable Equipment; D006499:Hepatic Artery; D006801:Humans; D016867:Immunocompromised Host; D015918:Infusion Pumps, Implantable; D007261:Infusions, Intra-Arterial; D015470:Leukemia, Myeloid, Acute / Q000150:complications*; D008100:Liver Abscess / Q000188:drug therapy* / Q000209:etiology; D008297:Male; D008875:Middle Aged
D000935:Antifungal Agents; D000666:Amphotericin B