Nebulized liposomal amphotericin B and combined systemic antifungal therapy for the treatment of severe pulmonary aspergillosis after allogeneic hematopoietic stem cell transplant for a fatal mitochondrial disorder.
Nebulized liposomal amphotericin B (20-15 mg twice daily by nebulizer) was combined with high dose intravenous liposomal amphotericin B (10 mg/kg/day) and high dose caspofungin (100 mg/m(2)) for the treatment of severe, recurrent pulmonary aspergillosis following allogeneic hematopoietic stem cell transplantation from alternative donor in a patient with mitochondrial disease (Pearson's syndrome). This combined treatment was administered for 8 days. Nebulized liposomal amphotericin B was well tolerated. Since severe transplant complications developed, nebulized administration was withdrawn and intravenous doses of liposomal amphotericin B and caspofungin were tapered to usual schedules. Pulmonary aspergillosis responded well to 45 days of combined intravenous antifungal therapies which were maintained for 2 years with secondary prophylaxis, because of persistent immunosuppressive treatment.
Castagnola
E
E
Infectious Diseases Unit, G. Gaslini Children's Hospital, Genoa, Italy. eliocastagnola@ospedale-gaslini.ge.it
Moresco
L
L
Cappelli
B
B
Cuzzubbo
D
D
Moroni
C
C
Lanino
E
E
Faraci
M
M
D000280:Administration, Inhalation; D000666:Amphotericin B / Q000008:administration & dosage / Q000627:therapeutic use*; D000935:Antifungal Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001228:Aspergillosis / Q000188:drug therapy*; D000077336:Caspofungin; D004338:Drug Combinations; D004359:Drug Therapy, Combination; D054714:Echinocandins; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D007275:Injections, Intravenous; D055666:Lipopeptides; D008172:Lung Diseases, Fungal / Q000188:drug therapy*; D028361:Mitochondrial Diseases / Q000628:therapy*; D010456:Peptides, Cyclic / Q000627:therapeutic use; D010713:Phosphatidylcholines / Q000008:administration & dosage / Q000627:therapeutic use*; D010715:Phosphatidylglycerols / Q000008:administration & dosage / Q000627:therapeutic use*; D013577:Syndrome; D014184:Transplantation, Homologous
D000935:Antifungal Agents; D004338:Drug Combinations; D054714:Echinocandins; D055666:Lipopeptides; D010456:Peptides, Cyclic; D010713:Phosphatidylcholines; D010715:Phosphatidylglycerols; C068538:liposomal amphotericin B; D000666:Amphotericin B; D000077336:Caspofungin