amphotericin-b and Granulomatosis-with-Polyangiitis

Saksenaea species (spp.) are uncommon causes of mucormycosis but are emerging pathogens mostly associated with trauma and soil contamination often in immunocompetent hosts. Due to lack of sporulation in the laboratory, diagnosis and susceptibility testing is difficult so optimal treatment regimens are unknown.. A 67 year-old man from the Northern Territory in Australia, with a history of eosinophilic granulomatosis with polyangiitis, developed disseminated Saksenaea infection after initially presenting with symptoms consistent with bacterial pyelonephritis. Despite a delay in diagnosis; with aggressive surgical management and dual therapy with amphotericin B and posaconazole, he survived.. We describe an unusual case of disseminated infection with a favourable outcome to date.

Topics: Aged; Amphotericin B; Antifungal Agents; Granulomatosis with Polyangiitis; Humans; Immunocompromised Host; Male; Mucormycosis; Northern Territory; Triazoles

A 43-year-old Brazilian female presented in 2001 with nasal stuffiness and sinusitis. A biopsy was consistent with limited Wegener's granulomatosis although antineutrophil cytoplasmic antibodies were negative. Her nasal inflammation progressed despite trials of prednisone, methotrexate, and azathioprine. A septal perforation developed and a repeat biopsy showed granulomatous inflammation. In 2006 the patient was referred to Division of Rheumatology, University of California, Los Angeles. The nose was grossly erythematous and a magnetic resonance imaging revealed nasal destruction and sinusitis. Palatine biopsies showed chronic inflammation. Cyclophosphamide at 150 mg/d resulted in markedly improved mucocutaneous lesions. The patient developed a leg and arm rash in 2007. A skin biopsy was positive for Leishmania braziliensis. The cyclophosphamide was discontinued and amphotericin B was initiated with transient benefit. Remission was achieved with pentavalent antimony. Despite multiple nasopharyngeal biopsies, for a 6-year span, mucocutaneous leishmaniasis masqueraded as Wegener's granulomatosis. Cyclophosphamide not only resulted in clinical improvement, due to reduced inflammatory response, but also allowed widespread cutaneous dissemination.

Topics: Adult; Amphotericin B; Antiprotozoal Agents; Brazil; California; Diagnosis, Differential; Female; Granulomatosis with Polyangiitis; Humans; Infusions, Intravenous; Leishmaniasis, Mucocutaneous; Meglumine; Meglumine Antimoniate; Organometallic Compounds; Referral and Consultation

Topics: Adult; Amphotericin B; Antifungal Agents; Diagnosis, Differential; Drug Therapy, Combination; Granulomatosis with Polyangiitis; Humans; Immunocompromised Host; Male; Mucormycosis; Radiography, Thoracic; Recurrence; Treatment Outcome; Triazoles

Cryptococcosis is the third most common invasive fungal infection in organ transplant recipients after candidiasis and aspergillosis. It occurs almost exclusively in the late posttransplantation period (>6 months after the initiation of immunosuppression). Subclinical onset of meningitis is the usual clinical presentation. Despite initiation of therapy, the mortality rate associated with this infection in this patient population remains high. To the best of our knowledge, this report describes one of the first cases of a rare entity: a primary cutaneous cryptococcosis in a renal transplant recipient disclosed by skull osteomyelitis and pseudotumoral intracranial extension. Surgical debridement and azole antifungal therapy were performed. Ten months after the onset of treatment, the patient feels good, clinical examination findings are normal, and no sign of evolutive cryptococcosis is noted.

Topics: Abscess; Amphotericin B; Animals; Antifungal Agents; Combined Modality Therapy; Cryptococcosis; Debridement; Diagnosis, Differential; Ducks; Environmental Exposure; Facial Injuries; Fluconazole; Graft Rejection; Granuloma; Granulomatosis with Polyangiitis; Humans; Immunocompromised Host; Immunosuppression Therapy; Immunosuppressive Agents; Kidney Transplantation; Male; Middle Aged; Opportunistic Infections; Osteitis; Osteolysis; Parietal Bone; Postoperative Complications; Remission Induction; Seminoma; Skull Neoplasms; Subcutaneous Tissue; Testicular Neoplasms

Topics: Aged; Amphotericin B; Animals; Antiprotozoal Agents; Granulomatosis with Polyangiitis; Humans; Leishmania infantum; Leishmaniasis, Visceral; Male

Leishmaniasis in a patient with Wegenerís disease raises the problem of amphotericin toxicity further compromising the pre-existing renal disorder.. An anemic patient treated for Wegenerís disease developed visceral leishmaniasis. This renal failure patient was treated with lipid complex amphotericin B and liposomal amphotericin B. We report outcome at 10 months follow-up.. The new formulations of amphotericin B allow effective treatment of visceral leishmaniasis in renal failure patients. Long-lasting results are probably favored by the interruption of immuno-suppressive therapy.

Topics: Acute Kidney Injury; Aged; Amphotericin B; Anemia; Anti-Bacterial Agents; Female; Follow-Up Studies; Granulomatosis with Polyangiitis; Humans; Leishmaniasis, Visceral; Liposomes; Male; Treatment Outcome

We have described a patient with cavitary pulmonary fungal infection, probably blastomycosis, with necrotizing arteritis of the skin. The pulmonary and skin lesions resolved with amphotericin B therapy.

Topics: Adult; Amphotericin B; Arteritis; Blastomycosis; Dermatomycoses; Diagnosis, Differential; Female; Granulomatosis with Polyangiitis; Humans; Lung Diseases, Fungal; Necrosis