amphotericin-b and Aneurysm--False

Topics: Amphotericin B; Aneurysm, False; Antifungal Agents; Humans; Lung; Mucormycosis; Pulmonary Artery

Mucormycosis is an emerging and fatal fungal infection. A high index of suspicion and the knowledge of its potential manifestations are essential for early diagnosis. We describe a patient with acute lymphoblastic leukaemia (L2 subtype) who developed a neck mass following a course of induction chemotherapy. Doppler ultrasonography and angiography of the neck revealed a pseudoaneurysm of the right common carotid artery. The patient then developed haemoptysis. Surgical exploration revealed a necrotic right common carotid artery with anteromedial pseudoaneurysm and adjacent tracheal wall perforation. Local debridement and tracheal repair were performed. Nonseptate hypheal invasion (mucormycosis) was found on the microscopic examination of the excised arterial wall. A subsequent recurrence of pseudoaneurysm was treated with local surgical debridement and intravenous amphotericin B (Fungizone) administration. Although rare, clinicians should be aware of these possible presenting features of mucormycosis as early diagnosis and treatment may potentially improve the survival.

Topics: Adult; Amphotericin B; Aneurysm, False; Antifungal Agents; Carotid Artery, Common; Humans; Male; Mucorales; Mucormycosis; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Radiography; Tracheal Diseases; Ultrasonography

A Mucorales infection of an external iliac artery stent in a renal transplant patient is described. Following a kidney transplantation operation and an acute rejection of the transplant, an aneurysm developed at the site of the arterial ligation and three stents were inserted. Two months following insertion of the stents, recurrent episodes of peripheral thromboembolism occurred. Histological examination of the thrombus revealed hyphae characteristic of mucormycosis. A combination of surgical and medical treatment with intravenous liposomal amphotericin B was applied, which led to complete cure of the disease without infection recurrence after 1 year of follow-up.

Topics: Acute Kidney Injury; Adult; Amphotericin B; Aneurysm, False; Angioplasty; Antifungal Agents; Graft Rejection; Humans; Iliac Aneurysm; Kidney Transplantation; Male; Mucormycosis; Prosthesis-Related Infections; Stents; Treatment Outcome

We describe a clinical case of two patients who received a cadaveric renal graft from the same donor in a multi-organ extraction procedure. The donor was a 39-years-old woman who died of intracranial tumour. A benign ganglioma was shown in biopsy. The two recipients received the same immunosuppressive regimen. Induction comprised cyclosporin A, steroids and basiliximab while cyclosporin A and steroids were used in maintenance immunosuppression. The A patient was a 53-year-old woman with chronic renal failure due to chronic pyelonephritis. She had been undergoing periodic haemodialysis for five years. She was hospitalised for sciatic pain refractory to rest and analgesics 35 days after transplantation. Two days later, her graft function deteriorated. Ultrasonography ruled out a urinary tract obstruction. Cyclosporine levels was normal. It was interpreted as an acute rejection episode and was treated with boluses of methylprednisolone (500 mg for 3 days). At the same time, her right leg began to show paraesthesia, coldness and a decreased arterial pulse. A spinal magnetic nuclear resonance was performed. It showed an aneurysm of right common iliac artery (fig. 1). An arteriography confirmed the existence of a pseudoaneurysm and an arteriovenous fistula to inferior vena cava (fig. 2). The B recipient was a 56-year-old woman with chronic renal failure due to chronic pyelonephritis. She required haemodialysis for two years. In the 4th month after transplantation her graft function deteriorated. Graft biopsy did not show acute cellular rejection, so she was kept on immunosuppressive treatment. A second graft biopsy was taken and no changes with the previous one was observed. Renal function deteriorated and haemodialysis was required. During the 6th month she began to show paraesthesia, coldness and decreased arterial pulse in her right leg. Ultrasonography showed pyelocaliectasis with an adjacent solid-liquid mass, abdominal CT scan confirmed. Arteriography proved the presence of a pseudoaneurysm of the right common iliac artery (fig. 3). Transplantectomy and pseudoaneurysm resection was performed in the two cases. Culture analysis revealed fungi identified as Aspergillus in both pseudoaneurysms. Medical treatment was started immediately with liposomal amphotericin B. The clinical evolution of the two recipients were different. While recipient A died, B patient recovered, requiring haemodialysis.

Topics: Adrenal Cortex Hormones; Adult; Amphotericin B; Aneurysm, False; Aneurysm, Infected; Antibodies, Monoclonal; Arteriovenous Fistula; Aspergillosis; Basiliximab; Cadaver; Combined Modality Therapy; Cyclosporine; Fatal Outcome; Female; Humans; Iliac Artery; Immunocompromised Host; Kidney Transplantation; Liposomes; Middle Aged; Nephrectomy; Postoperative Complications; Pyelonephritis; Recombinant Fusion Proteins; Tissue Donors; Transplants; Vena Cava, Inferior

The authors report 2 cases of patients who underwent cadaveric renal transplantation from the same donor in a multiorgan extraction procedure. Both cases showed, during the first 6 months posttransplantation, a worsening in renal graft function and signs of ischemia in the homolateral lower limb. One of the cases was preceded by pain in the sciatic region. In imaging tests, a pseudoaneurysm was detected in the iliac artery in both patients. Grafts had to be removed, and the iliac arteries were ligated with posterior isolation of Aspergillus spp from the arterial vessels but not from the renal tissue. Besides surgery, medical treatment with liposomal amphotericin B was initiated with a different outcome in each patient: patient A died, whereas patient B recovered. The absence of Aspergillus spp infection in liver and heart recipients ruled out a donor-transmitted infection. The graft placements were carried out in different operating rooms, which rules out contamination during the transplantation process. All of this leads us to conclude that the infection must have occurred during the preservation phase of the kidney.

Topics: Adult; Amphotericin B; Aneurysm, False; Antifungal Agents; Aspergillosis; Cadaver; Drug Administration Schedule; Female; Humans; Iliac Aneurysm; Iliac Artery; Kidney; Kidney Transplantation; Middle Aged; Renal Artery; Tissue Donors

Mucormycosis is an uncommon and frequently fatal fungal infection. It characteristically affects patients with diabetes mellitus or patients with severe immunosuppression. The hallmark of mucormycosis infection is tissue infarction and vascular invasion. We present clinical data and imaging studies of a 16 year-old child with acute lymphoblastic leukemia complicated by disseminated mucormycosis resulting in a pseudoaneurysm of the spleen. This was successfully managed by a combination of systemic antifungal therapy (Amphotericin B) and surgery (splenectomy). This entity has not been described in the literature.

Topics: Adolescent; Amphotericin B; Aneurysm, False; Antifungal Agents; Female; Humans; Leukemia, Lymphoid; Mucormycosis; Splenectomy; Splenic Diseases

A 55-year-old woman developed end-stage liver disease and the hepatorenal syndrome secondary to cryptogenic cirrhosis. Orthotopic liver transplantation was complicated by bile peritonitis, requiring reoperation and eventual placement of an internal biliary stent. On postoperative day 26, hemobilia was caused by localized rupture of mycotic (Aspergillus fumigatus) hepatic artery pseudoaneurysms with fistulization into the biliary tree. After arterial reconstruction with a reversed autologous saphenous vein graft, the patient was treated successfully with liposomal amphotericin B.

Topics: Amphotericin B; Aneurysm, False; Drug Carriers; Female; Hepatic Artery; Humans; Liposomes; Middle Aged; Mycoses; Radiography