Use of posaconazole in the treatment of infective rhinocerebral mucormycosis.
BACKGROUND
A patients with undiagnosed type II diabetes mellitus presented with infective rhinocerebral mucormycosis. INVESTIGATION RESULTS: Initial magnetic resonance imaging scans demonstrated an aggressive disease process involving the left orbit and paranasal sinuses. A repeated scan following treatment excluded intracranial spread or recurrence. Pus from the paranasal sinuses grew Rhizopus arrhizus on microbiological culture.


RESULTS
Initial treatment comprised intravenous liposomal amphotericin B, intravenous co-amoxiclav and surgical debridement. The patient's diabetes was managed medically. The development of drug-induced transaminitis required a change of medication. The dose of liposomal amphotericin B was reduced, and then titrated back up as the liver function test results improved. Posaconazole was also introduced and the patient was eventually discharged on this alone, as the maximum recommended cumulative dose of liposomal amphotericin B had been reached.


CONCLUSIONS
Posaconazole may be used effectively in conjunction with surgical debridement in the treatment of patients with infective rhinocerebral mucormycosis who develop hepatotoxic side effects to liposomal amphotericin B. Posaconazole may also allow a reduction in the dose of liposomal amphotericin B, resulting in better tolerance.
Kulendra
K
K
Department of ENT, Charing Cross Hospital, London, UK. knk79@blueyonder.co.uk
Habibi
M
M
Butler
C
C
Clarke
P
P
Howard
D
D
D000935:Antifungal Agents / Q000627:therapeutic use*; D001927:Brain Diseases / Q000188:drug therapy* / Q000382:microbiology; D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009091:Mucormycosis / Q000188:drug therapy*; D009916:Orbital Diseases / Q000188:drug therapy; D010254:Paranasal Sinus Diseases / Q000188:drug therapy* / Q000382:microbiology; D012233:Rhizopus / Q000302:isolation & purification; D014230:Triazoles / Q000627:therapeutic use*
D000935:Antifungal Agents; D014230:Triazoles; C101425:posaconazole