amphotericin-b and Giant-Cell-Arteritis

Horton giant cell arteritis can present with an atypical clinical picture that often resembles other diseases. In the case described below, the patient initially demonstrated clinical and laboratory evidence of a Candida albicans sepsis, and therefore we started antimycotic treatment with amphotericin B. Because of an adverse reaction to that drug, we added parenteral steroids before every administration of the antimycotic which led to an unexpected improvement of symptoms. This result caused us to reconsider some clinical aspects that could have been interpreted also as vasculitis, in particular for a giant cell arteritis: throbbing temporal headache, diffuse weakness, important rise in ESR, myoarthralgias. We performed a biopsy of the temporal artery that confirmed our diagnosis.

Topics: Amphotericin B; Anti-Inflammatory Agents; Antifungal Agents; Biopsy; Candidiasis; Drug Hypersensitivity; Drug Therapy, Combination; Giant Cell Arteritis; Humans; Hydrocortisone; Male; Middle Aged; Prednisone; Recurrence; Temporal Arteries

We present the case of a 74-y-old HIV-negative female who suffered simultaneously from multiple opportunistic infections and a Klebsiella pneumoniae sepsis during high-dose steroids for giant cell arteritis. The patient was treated with a purine analog due to hairy cell leukaemia 10 y previously. Purine analog therapy can lead to long lasting defects in cell-mediated immunity. In these patients, treatment with steroids should be closely monitored with CD4 counts.

Topics: Aged; Amphotericin B; Anti-Bacterial Agents; Anti-Inflammatory Agents; Antifungal Agents; Antineoplastic Agents; Aspergillosis; Cladribine; Cytomegalovirus; Dexamethasone; Esophagitis; Female; Giant Cell Arteritis; Herpes Simplex; Humans; Klebsiella Infections; Klebsiella pneumoniae; Leukemia, Hairy Cell; Methylprednisolone; Opportunistic Infections; Pneumocystis carinii; Trimethoprim, Sulfamethoxazole Drug Combination

A case of rhinocerebral mucormycosis occurring in a 41-year-old man with insulin-treated diabetes mellitus is reported. Microscopically, biopsy samples obtained from the left ethmoid and middle turbinate sinuses contained fungi that formed mycotic granulomas associated with multinucleate giant cell arteritis. The multinucleate giant cells contained broad, infrequently septate hyphase consistent with mucormycosis. The patient received surgical debridement with extenteration of the left orbit, and intravenous liposome-encapsulated amphotericin B. After 12 months, examination of the patient revealed complete healing. Multinucleate giant cell granulomas and arteritis are only exceptionally associated with rhinocerebral mucormycosis, but these histologic findings may be correlated with a progressive disease with better prognosis.

Topics: Acute Disease; Adult; Amphotericin B; Antifungal Agents; Biopsy; Debridement; Ethmoid Sinus; Giant Cell Arteritis; Granuloma, Foreign-Body; Humans; Male; Mucorales; Mucormycosis; Orbit; Paranasal Sinus Diseases; Survival Rate; Treatment Outcome; Turbinates