Progressive disseminated aspergillosis in a bone marrow transplant recipient: response with a high-dose lipid formulation of amphotericin B.
We present a case of progressive disseminated aspergillosis that involved multiple sites in a bone marrow transplant recipient with severe, chronic graft-versus-host disease. The patient failed to respond to treatment with a conventional dosage of a lipid formulation of amphotericin B (lifoAmB; 5 mg/kg/day) given alone or in combination with itraconazole, and he responded only to an aggressive strategy that included a very high dosage of lifoAmB (15 mg/kg/day) given in combination with itraconazole as well as a rapid reduction in immunosuppression. Despite the patient's abnormal baseline kidney function, the very high doses of lifoAmB were well tolerated and did not result in additional renal toxicity.
Dept. of Internal Medicine Specialties, The University of Texas M. D. Anderson Cancer Center, Houston, TX, 77030, USA. dkontoyi@notes.mdacc.tmc.edu
D P
DP
Kontoyiannis
B S
BS
Andersson
R E
RE
Lewis
I I
II
Raad
D000328:Adult; D000666:Amphotericin B / Q000627:therapeutic use*; D000935:Antifungal Agents / Q000627:therapeutic use*; D001228:Aspergillosis / Q000188:drug therapy* / Q000382:microbiology; D001232:Aspergillus fumigatus / Q000302:isolation & purification*; D016026:Bone Marrow Transplantation / Q000009:adverse effects*; D004359:Drug Therapy, Combination; D006086:Graft vs Host Disease / Q000628:therapy; D006801:Humans; D017964:Itraconazole / Q000627:therapeutic use; D008297:Male; D016896:Treatment Outcome
D000935:Antifungal Agents; C068538:liposomal amphotericin B; D017964:Itraconazole; D000666:Amphotericin B