Factitious fungus in two children with cancer receiving liposomal amphotericin.
Amphotericin B deoxycholate and liposomal formulations of amphotericin are often started and continued empirically, in immunocompromised hosts, based on the computed tomography findings and the patient's clinical picture. The authors describe two patients with presumed fungal pulmonary nodules, which were progressive despite prolonged treatment with liposomal amphotericin B. At subsequent biopsy, neither had evidence of active fungal disease; rather, the nodules revealed reactive changes and lipid-laden macrophages. These cases underscore the importance of establishing a microbiologic diagnosis in cases of presumed fungal infection.
Fisher
Michael J
MJ
Department of Pediatrics, Children's Hospital of Philadelphia, Pennsylvania 19104, USA. fisherm@email.chop.edu
Guttenberg
Marta
M
Kramer
Sandra S
SS
Bell
Louis M
LM
Lange
Beverly J
BJ
D000293:Adolescent; D000666:Amphotericin B / Q000627:therapeutic use*; D000935:Antifungal Agents / Q000627:therapeutic use*; D002648:Child; D003951:Diagnostic Errors; D006801:Humans; D016867:Immunocompromised Host; D015470:Leukemia, Myeloid, Acute / Q000150:complications* / Q000175:diagnosis; D008081:Liposomes; D008172:Lung Diseases, Fungal / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D008297:Male; D008400:Mass Chest X-Ray; D009181:Mycoses / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D011014:Pneumonia / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D014057:Tomography, X-Ray Computed
D000935:Antifungal Agents; D008081:Liposomes; D000666:Amphotericin B