title: Rhinocerebral mucormycosis treated with amphotericin B colloidal dispersion in three patients.
abstract: Rhinocerebral mucormycosis (zygomycosis) primarily affects diabetic or immunosuppressed patients and typically progresses rapidly, necessitating surgical excision and antifungal therapy with amphotericin B. Large doses of amphotericin B are required for cure, causing significant renal toxicity. Amphotericin B colloidal dispersion (ABCD; Amphocil, Sequus Pharmaceuticals, Menlo Park, CA) is a 1:1 complex of cholesteryl sulfate and amphotericin B, which results in significant reduction of toxicity, especially nephrotoxicity. We describe three patients with life-threatening rhinocerebral mucormycosis treated with ABCD. All patients had high serum creatinine levels due to prior treatment with amphotericin B; these levels reverted to normal during treatment with ABCD. Two patients with diabetes mellitus were cured after receiving a combination of surgery and ABCD therapy. The third patient, who had myelodysplastic syndrome, had an initial good response, with cure of the fungal infection; however, he eventually died of his primary illness. To the best of our knowledge, this is the first detailed clinical description of the treatment of mucormycosis with ABCD.
authors.affiliation: Departments of Clinical Microbiology and Infectious Diseases, Hebrew University-Hadassah Medical School, Jerusalem, Israel.
authors.forename: A E
authors.initials: AE
authors.lastname: Moses
authors.forename: G
authors.initials: G
authors.lastname: Rahav
authors.forename: Y
authors.initials: Y
authors.lastname: Barenholz
authors.forename: J
authors.initials: J
authors.lastname: Elidan
authors.forename: B
authors.initials: B
authors.lastname: Azaz
authors.forename: S
authors.initials: S
authors.lastname: Gillis
authors.forename: M
authors.initials: M
authors.lastname: Brickman
authors.forename: I
authors.initials: I
authors.lastname: Polacheck
authors.forename: M
authors.initials: M
authors.lastname: Shapiro
mesh_terms: D000328:Adult; D000368:Aged; D000666:Amphotericin B / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D000935:Antifungal Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D003404:Creatinine / Q000097:blood; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009091:Mucormycosis / Q000188:drug therapy*; D009894:Opportunistic Infections / Q000188:drug therapy; D010254:Paranasal Sinus Diseases / Q000188:drug therapy* / Q000382:microbiology
chemical_list: D000935:Antifungal Agents; D000666:Amphotericin B; D003404:Creatinine