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.
Kontoyiannis
D P
DP
Dept. of Internal Medicine Specialties, The University of Texas M. D. Anderson Cancer Center, Houston, TX, 77030, USA. dkontoyi@notes.mdacc.tmc.edu
Andersson
B S
BS
Lewis
R E
RE
Raad
I I
II
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