amphotericin-b and Liver-Abscess

Neonatal liver abscess is an uncommon seen condition in neonatology and it holds a very high neonatal mortality because of difficulty in diagnosis and treatment. Till today, only few instances are reported that too are mainly in preterm. Its diagnosis requires a high index of suspicion. Fungal hepatic abscess is very rare and in medical literature very few case reports are there in the medical literature. Here, we report a case of Candida albicans liver abscess in a preterm neonate, secondary to malpositioned umbilical lines that presented with respiratory difficulty and other clinical features of sepsis that was managed medically and discharged successfully.

Topics: Amphotericin B; Antifungal Agents; Candida; Candidiasis; Catheterization, Central Venous; Fluconazole; Humans; Infant, Newborn; Infant, Premature; Liver Abscess; Male; Treatment Outcome; Umbilical Veins

Cryptococcus neoformans usually involves the central nervous system and the respiratory tract. We report a case of disseminated cryptococcosis with a liver abscess and meningoencephalitis in a patient with myelodysplastic syndrome. Computed tomography of the abdomen showed a 3-cm low-attenuated lesion in the left lobe of liver. Cultures from specimens of blood, the liver abscess, and the cerebrospinal fluid all yielded C. neoformans. The cryptococcal antigen titers for the serum and cerebral fluid were both 1:32. The patient was successfully treated with 1,335 mg of amphotericin-B followed by fluconazole. Most cryptococcal liver infections present as hepatitis, cholangitis, or microabscesses.

Topics: Aged; Amphotericin B; Anti-Bacterial Agents; Antifungal Agents; Antigens, Fungal; Cryptococcosis; Cryptococcus neoformans; Female; Fluconazole; Humans; Liver Abscess; Tomography, X-Ray Computed; Ultrasonography

Case 1. A 34-year-old male was admitted in July, 1986 with a diagnosis of AML (M2). Two courses of BHAC-DMP regimen induced complete remission in October, while marked pyrexia resistant to antibiotics remained. An ultrasonography (US) and computed tomography (CT) revealed multiple liver and spleen abscesses suspected of mycotic etiology. Administration of amphotericin B (AMPH-B) by intravenous injection was difficult owing to its severe side effect. Multiple abscesses increased in the size and number despite treatment with Miconazole (MCZ) and Ketoconazole. Exploratory laparotomy was performed with splenectomy, and splenic specimens were found to contain Candida organisms. Soon AMPH-B was administered through a catheter inserted into the portal vein at the same time. A side effect by AMPH-B was tolerable and his fever resolved to normal in 2 weeks after institution of this therapy, and the sizes of abscesses were markedly reduced. The patient remained in remission through 23 months, free of fungal infection. Case 2. A 23-year-old female was admitted for relapse of ALL (L2), in April, 1987. Reinduction therapy with BHAC-L-AVP achieved again in May but fever unresponsive to antibiotics occurred. Since multiple liver-spleen abscesses were showed by US and CT suspected mycotic etiology, antimycotic therapy with Miconazole and AMPH-B was performed but clinical findings were deteriorated. AMPH-B was administered through a catheter inserted into the hepatic artery for two weeks, following into the splenic artery for a week. Splenic abscesses were resolved in a week and liver abscesses were markedly reduced at three weeks after initiation of intra-arterial antifungal treatment. Through the analysis of these case studies we confirmed the usefulness of intraportal and intrahepatosplenic arterial administration of AMPH-B.

Topics: Abscess; Acute Disease; Adult; Amphotericin B; Catheters, Indwelling; Female; Hepatic Artery; Humans; Leukemia; Liver Abscess; Male; Mycoses; Portal Vein; Splenic Artery; Splenic Diseases

We report the first case of liver abscess due to Sterigmatomyces halophilus. Because this pathogen grows poorly in culture medium without added salts, it was identified by sequencing analysis targeting the rRNA gene internal transcribed spacer (ITS) region. This method could be useful for pathogens that cannot be cultured using standard methods.

Topics: Amphotericin B; Antifungal Agents; Antineoplastic Agents; Basidiomycota; Biopsy; Bone Marrow Transplantation; Cefozopran; Cephalosporins; Chemotherapy-Induced Febrile Neutropenia; Child; Hematopoietic Stem Cell Transplantation; Humans; Liver; Liver Abscess; Male; Micafungin; Mycoses; Neoplasm Recurrence, Local; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Treatment Outcome

Hepatic fungal abscesses are rare in the neonatal period and often constitute a severe complication of the catheterization of the umbilical vessels. Such life-threatening lesions are observed more frequently in preterm than in other newborn infants and the optimal treatment remains uncertain. We present the case of a preterm neonate, who developed an intrahepatic lesion due to parenteral extravasation, successively contaminated by

Topics: Amphotericin B; Antifungal Agents; Candida albicans; Candidiasis; Catheters, Indwelling; Humans; Infant, Newborn; Infant, Premature; Injections, Intralesional; Intensive Care Units, Neonatal; Liver; Liver Abscess; Treatment Outcome

We describe a case of hepatic mucormycosis with abscess, an uncommon presentation of mucormycetes infection. Our patient was initially treated with transcutaneous pigtail catheter placement, liposomal amphotericin B, and micafungin without improvement. The patient subsequently improved after hepatic segmentectomy and hemidiaphragm resection.

Topics: Amphotericin B; Antifungal Agents; Fatal Outcome; Humans; Liver Abscess; Male; Middle Aged; Mucor; Mucormycosis

A 26-year-old man with chronic granulomatous disease complicated by multiple liver abscess was admitted to our hospital for hepatic resection and allogeneic bone marrow transplantation (BMT) from an HLA-matched sibling. We diagnosed the patient with Aspergillus liver abscesses based on computed tomographic findings, elevated serum levels of beta-D-glucan, positive test for galactomannan antigen, and the findings of laboratory cultures. Since the liver abscess could not be treated by drainage and administration of antifungals, we resected the posterior segments of the liver, which contained the abscess (S1, S6). However, abscess recurred in the remaining part of the liver 1 month later. The patient received allogeneic BMT from an HLA-matched sibling. During BMT, we continuously administered liposomal amphotericin B (L-AMB) via the hepatic artery (25 mg/day) to treat the liver abscess. There were no adverse effects during hepatic arterial infusion of L-AMB, and the liver abscess disappeared after BMT. These results suggest that hepatic arterial infusion of L-AMB is effective in treating fungal abscess in the liver.

Topics: Adult; Amphotericin B; Aspergillosis; Bone Marrow Transplantation; Granulomatous Disease, Chronic; Hepatectomy; Hepatic Artery; Humans; Infusions, Intra-Arterial; Liver Abscess; Male; Treatment Outcome

Topics: Amphotericin B; Antifungal Agents; Candida albicans; Endocarditis, Bacterial; Fatal Outcome; Female; Hepatic Encephalopathy; Humans; Liver Abscess; Middle Aged; Splenic Diseases; Tomography, X-Ray Computed; Treatment Failure; Ultrasonography

We report a case of candidal liver abscesses and concomitant candidal cholecystitis in a diabetic patient, in whom differences were noted relative to those found in patients with hematologic malignancies. In our case, the proposed entry route of infection is ascending retrograde from the biliary tract. Bile and aspirated pus culture repeatedly tested positive, and blood negative, for Candida albicans and Candida glabrata. Cholecystitis was cured by percutaneous gallbladder drainage and amphotericin B therapy. The liver abscesses were successfully treated by a cumulative dosage of 750 mg amphotericin B. We conclude that in cases involving less immunocompromised patients and those without candidemia, a lower dosage of amphotericin B may be adequate in treating candidal liver abscesses.

Topics: Adult; Amphotericin B; Antifungal Agents; Candidiasis; Cholecystitis; Humans; Liver Abscess; Liver Neoplasms; Male

Invasive fungal infections are more commonly found in patients who develop neutropenia after chemotherapy. A 4-year-old girl with diagnosis of acute lymphoid leukemia developed febrile neutropenia after chemotherapy. Broad spectrum antibiotics and antimycotic therapy were initiated. Candida albicans was isolated and Entamoeba histolytica was observed in stool examination. Chronic disseminated candidiasis had developed and was treated with amphotericin B, initially, and fluconazol. Computed tomography images were obtained that demonstrated a classic 'bull's eye' pattern; a concurrent histological study confirmed the diagnosis. Candida spp. is the major cause of opportunistic mycosis in immunosuppresed patients receiving chemotherapy for haematologic malignancies. An initial infection results in disseminated candidiasis, which persists and becomes chronic. In the 4-year-old patient, the identified risk factors consisted of a previous therapy with broad spectrum antibiotics, the gastrointestinal tract colonization with Candida albicans and prolonged neutropenia. Imaging diagnoses are made by ultrasonography, computed tomography and magnetic resonance. With ultrasound and tomography, 4 distinct patterns have been described. Pattern 1 ('wheels within wheels') and 2 ('bull's eye') are important, since they are characteristic of chronic disseminated candidiasis. The third pattern (hypoechoic image) is the most common finding with both techniques. In the current patient, patterns 2 and 3 were seen and the diagnosis was confirmed by histological study.

Topics: Amphotericin B; Animals; Antifungal Agents; Candidiasis; Child, Preschool; Drug Therapy, Combination; Entamoeba histolytica; Feces; Female; Fluconazole; Humans; Liver Abscess; Tomography, X-Ray Computed

Hepatosplenic microabscesses secondary to invasion by various organisms may result in life-threatening conditions, especially in patients with cancer. Whether these patients should continue ongoing cytotoxic therapy, which might result in neutropenia, with the risk of progressive abscess formation or fungemia, remains a dilemma. We report five cases of pediatric acute leukemia with hepatosplenic microabscesses in children aged 4 years to 18 years. These patients presented with prolonged fever and neutropenia after antineoplastic chemotherapy, followed by abdominal pain, hepatosplenomegaly and hepatic dysfunction. Abdominal ultrasound and computed tomography (CT) or magnetic resonance imaging (MRI) demonstrated multiple small lesions compatible with hepatosplenic candidiasis in all of the patients. Cultures, including blood or stool cultures, were positive in only two cases. Treatment with intravenous antifungal agents, including amphotericin B, liposomal amphotericin B, and/or fluconazole were successful in two cases. These two patients remained event-free and survived for more than 24 months (20 months and 22 months after infection was diagnosed). The duration of systemic antifungal medication administration ranged from 3 months to 22 months. The serial image examinations revealed drastic reductions in small residual lesions in the two patients who survived the longest. The major issues for these patients were how long the antifungal therapy should be administered for, and how to select the optimal drug and dosage to avoid hepatic and renal toxicity. Among our patients, alternative therapy with amphotericin B, liposomal amphotericin B, and fluconazole was used according to the patients' conditions, and the duration of antifungal therapy was determined by clinical manifestations and imaging study changes.

Topics: Abscess; Acute Disease; Adolescent; Amphotericin B; Antifungal Agents; Candidiasis; Child; Child, Preschool; Drug Administration Schedule; Humans; Leukemia; Liver Abscess; Male; Splenic Diseases

To report an unusual ocular presentation of Candida glabrata in a patient with chronic granulomatous disease.. Interventional case report. A 15-year-old boy with chronic granulomatous disease presented with bilateral limbal infiltrates. He had been receiving broad-spectrum systemic antibiotics for recurrent liver abscesses. The keratitis did not respond to antibiotics and did not resolve after a course of topical steroids.. Corneal cultures revealed Candida glabrata. The same species was simultaneously isolated from the surgical drainage of the liver abscesses. The ocular and hepatic findings resolved on intravenous amphotericin B.. Candida glabrata has recently emerged as an important nosocomial pathogen. It may present as a limbal keratitis in the setting of systemic infection.

Topics: Adolescent; Amphotericin B; Antifungal Agents; Candida; Candidiasis; Cornea; Eye Infections, Fungal; Granulomatous Disease, Chronic; Humans; Keratitis; Liver Abscess; Male; Staphylococcal Infections; Visual Acuity

We report the first case of hepatitis due to Aspergillus terreus in a 13-year-old boy with common variable immunodeficiency that occurred while the patient was receiving secondary prophylaxis with fluconazole after an episode of pulmonary candidosis. The infection subsided after the addition of itraconazole to the combination of liposomal amphotericin B and granulocyte-macrophage colony-stimulating factor that he was receiving.

Topics: Adolescent; Amphotericin B; Antifungal Agents; Aspergillosis; Candida; Candidiasis; Drug Therapy, Combination; Fluconazole; Granulocyte-Macrophage Colony-Stimulating Factor; Humans; Immunocompromised Host; Itraconazole; Liposomes; Liver Abscess; Lung Diseases; Male; Treatment Outcome

Topics: Amphotericin B; Antifungal Agents; Fatal Outcome; Female; Humans; Liver Abscess; Middle Aged; Multiple Organ Failure; Mycoses; Saccharomyces cerevisiae

A 40-year-old man was diagnosed as having chronic myeloid leukemia (CML) in December 1990 and received busulfan and hydroxyurea. He developed myeloid blast crisis in February 1996. After DCMP combination chemotherapy, his disease reverted to chronic phase, but right hypochondrial pain developed and low-grade fever persisted. Abdominal CT scan revealed multiple low-density areas in the liver, suggestive of abscess formation. Grocott staining of a liver biopsy sample revealed granuloma and fungus. The patient was treated with intravenous amphotericin B (AMPH-B) without success. AMPH-B was then administered via a catheter placed in the portal vein on January 6, 1997, and an additional catheter placed in the hepatic artery on March 28. AMPH-B was administered through both catheters for more than two months, but later substituted by fluconazole because of renal impairment. On September 10, allogeneic bone marrow transplantation from the patient's HLA-identical brother was performed, despite persistence of the abnormal CT findings. Acute grade III GVHD developed, but there was no evidence of reactivation of the liver abscesses. This case demonstrates that a prior fungal liver abscess is not an absolute contraindication for BMT if prophylactic antifungal drugs are administered and careful observation is conducted.

Topics: Adult; Amphotericin B; Antifungal Agents; Antineoplastic Combined Chemotherapy Protocols; Blast Crisis; Bone Transplantation; Fluconazole; Humans; Leukemia, Myelogenous, Chronic, BCR-ABL Positive; Liver Abscess; Male; Mycoses; Transplantation, Homologous

We report a 26-year-old male patient with acute myelocytic leukemia and hepatosplenic candidiasis during his clinical course. His hepatosplenic candidiasis was refractoty to itraconazole and fluconazol. He developed serious side-effect such as renal dysfunction, when conventional amphotericin B was given. Then he was treated with liposomal amphotericin B (Abelcet). This therapy was safe and effective for him. He was able to be treated with 3075 mg of a liposomal amphotericin B. This was ten times as much as the dose of conventional amphotericin B which was given earlier until amphotericin B was stopped because of renal dysfunction. Liposomal amphotericin B seems to be a safe and effective therapy for systemic fungal infectin and should be considered more in Japan.

Topics: Adult; Amphotericin B; Antifungal Agents; Candidiasis; Humans; Leukemia, Myeloid, Acute; Liposomes; Liver Abscess; Male; Splenic Diseases

Topics: Adult; Amphotericin B; Antifungal Agents; Candidiasis; Humans; Infusions, Intravenous; Leukemia, Myeloid, Acute; Liver Abscess; Male; Opportunistic Infections; Treatment Outcome

A 49-year-old male was admitted with a diagnosis of AML (M2). One course of BHAC-DM regimen induced complete remission. During the consolidation therapy, he developed marked pyrexia resistent to antibiotics. Ultrasonography and CT scan revealed multiple small liver abscesses, which suggested mycotic etiology. After unsuccessful treatment with intravenous administration of fluconazole, a percutaneous transhepatic intraportal administration of Amphotericin B (AMPH-B) (20 mg/day) was started, followed by the consolidation chemotherapy. When the first positive blood culture was obtained for Candida, a reservoir was embedded in the subcutaneous layer of the right iliac region and the intrahepatic arterial administration of AMPH-B (5 to 20 mg/day) by the Infusor (Baxter Healthcare Corporation), a portable, disposable drug delivery system that provides a constant drug flow, was started. The liver abscesses has almost disappeared when the maintenance chemotherapy was completed. The side effects of AMPH-B were negligible. This case suggests the usefulness of the intrahepatic arterial infusion of AMPH-B using an inplantable drug delivery system in patients with hematological malignancies developing intractable multiple fungal liver abscesses.

Topics: Amphotericin B; Antifungal Agents; Candidiasis; Disposable Equipment; Hepatic Artery; Humans; Immunocompromised Host; Infusion Pumps, Implantable; Infusions, Intra-Arterial; Leukemia, Myeloid, Acute; Liver Abscess; Male; Middle Aged

The incidence of disseminated candidiasis is increasing. Liver involvement is frequent but rarely diagnosed. The authors report a case of disseminated candidiasis due to Candida glabrata with liver metastases. The presence of hepatic lesions was diagnosed by CT scan and parasitological examination of liver abscess contents obtained by CT-scan-directed puncture-aspiration. The outcome was favorable with amphotericin-B (cumulative dose of 1 g) and flucytosin. Aspects of hepatic involvement in disseminated candidiasis is discussed, together with the role of Candida glabrata in pathology of this type.

Topics: Aged; Amphotericin B; Candidiasis; Female; Flucytosine; Humans; Liver Abscess; Liver Diseases

Hepatosplenic candidiasis is increasingly observed in patients with a haematological malignancy who have received chemotherapy. A case history is described of a male aged 45 who developed symptoms of hepatosplenic candidiasis caused by Candida tropicalis after treatment for acute myeloid leukaemia. The disease is characterized by persistent fever after recovery of the leukopenia induced by the chemotherapy. Echographic and computer-tomographic examination may reveal abscess patterns specific of Candida in the liver. Treatment consists of amphotericin B intravenously or fluconazole orally. Protracted treatment is frequently required.

Topics: Amphotericin B; Antineoplastic Combined Chemotherapy Protocols; Candidiasis; Drug Therapy, Combination; Fluconazole; Humans; Leukemia, Myeloid, Acute; Liver Abscess; Male; Middle Aged; Splenic Diseases

To identify factors that may aid in the diagnosis and treatment of patients with malignant neoplasms in whom hepatic abscesses develop.. Retrospective review of medical records.. Thirty-seven oncology patients in whom hepatic abscesses developed at the National Cancer Institute, Bethesda, Md, between June 1954 and October 1989.. Among 37 cancer patients, bacterial abscesses developed in 17 and fungal abscesses developed in 20. Among the patients with bacterial abscesses, 12 (71%) had a solid-tissue malignant neoplasm, 10 (59%) had a prior invasive procedure, and six (35%) had prior chemotherapy. In comparison, among the patients with fungal abscesses, 15 (75%) had a hematologic malignant neoplasm and five (25%) had a solid-tissue malignant neoplasm (P2 = .014). Two patients with fungal abscesses (10%) had a prior invasive procedure (P2 = .004) and 19 (95%) had prior chemotherapy (P2 < .0001). As compared with fungal abscesses, bacterial abscesses were larger (P2 < .00001) and fewer (P2 = .004). Antibiotics and percutaneous or surgical drainage effectively treated bacterial abscesses. Amphotericin B usually eradicated hepatic fungal infections.. The results of this study reveal the importance of the clinical setting in the diagnosis of hepatic abscesses in cancer patients. Aggressive treatment of these abscesses is indicated and is frequently effective.

Topics: Adult; Aged; Amphotericin B; Anti-Bacterial Agents; Bacterial Infections; Drainage; Female; Humans; Liver Abscess; Male; Medical Audit; Middle Aged; Mycoses; Neoplasms; Retrospective Studies; Risk Factors; Survival Rate

Topics: Adolescent; Amphotericin B; Candidiasis; Female; Humans; Immunocompromised Host; Infusions, Intravenous; Liver Abscess; Opportunistic Infections; Portal Vein; Precursor Cell Lymphoblastic Leukemia-Lymphoma

Disseminated fungal infection not infrequently complicates the course of allogeneic bone marrow transplantation (allo BMT) in severely immunocompromised patients, and the prognosis of BMT patients who develop systemic fungal infection is very poor. We describe a patient who developed disseminated Candida albicans infection with liver abscess after the first allo BMT for acute myelogenous leukemia (FAB M2). The infection was successfully eradicated by the administration of miconazole and amphotericin B. However, 1 year after the first allo BMT, the patient suffered a relapse of acute myelogenous leukemia with fungal liver abscess. A second allo BMT, accelerating granulocyte recovery by recombinant human granulocyte colony-stimulating factor (rhG-CSF), was successfully performed and the fungal liver abscess resolved with a combination therapy of fluconazole and amphotericin B. The patient is alive and free of both leukemia and fungal disease more than 37 months after the first allo BMT and 25 months after the second allo BMT.

Topics: Adult; Amphotericin B; Bone Marrow Transplantation; Candidiasis; Drug Therapy, Combination; Female; Fluconazole; Granulocyte Colony-Stimulating Factor; Humans; Leukemia, Myeloid, Acute; Liver Abscess; Neoplasm Recurrence, Local; Recombinant Proteins

A 40-year-old female was admitted in August 1989 with a diagnosis of acute promyelocytic leukemia (AML; M3). One course of modified-DCMP regimen induced complete remission in September, but she developed spiking fever at a nadir period of WBC after induction chemotherapy. CT revealed multiple hepato-splenic abscesses presumably due to candida infection. She was treated with intravenous administration of amphotericin B (AMPH-B) and other antifungal agents. Despite the hematological remission and prolonged use of these antifungal agents, high fever persisted. A catheter was inserted into the portal vein under ultrasonic-guidance. AMPH-B was administered through the catheter: the initial dose was 3 mg/day and was soon increased to 20 mg/day. Her fever subsided in 1 week, and the sizes of liver abscesses on CT reduced markedly. Chill and hypokalemia were observed during this therapy. The catheter was removed from the portal vein after 29 days. Partial portal vein thrombosis was noted around the catheter tip. This case suggests the usefulness of intraportal administration of AMPH-B in patients with hematological malignancy developing multiple liver abscesses.

Topics: Abscess; Adult; Amphotericin B; Catheterization; Female; Humans; Leukemia, Promyelocytic, Acute; Liver Abscess; Portal Vein; Splenic Diseases

A 59-year-old female with acute promyelocytic leukemia in remission was admitted to our center because of an episode of incidental high fever with general fatigue. She was found to have hepatomegaly. Abdominal CT revealed multiple liver abscesses and a positive culture was obtained for candida albicans from an aspirated abscess. She was treated with percutaneous transhepatic intraportal administration of amphotericin B in addition to oral and intravenous administration. We confirmed the remission of these abscesses by means of the fungal index which is the difference between the values of the limulus test and endotoxin specific test. The fungal index appears to be useful for early diagnosis and treatment of fungal infection.

Topics: Amphotericin B; Candida albicans; Candidiasis; Female; Humans; Infusions, Intravenous; Liver; Liver Abscess; Middle Aged; Portal Vein

Topics: Adult; Amphotericin B; Candidiasis; Drug Carriers; Humans; Leukemia, Myeloid, Acute; Liposomes; Liver Abscess; Male

A 46-year-old male was admitted to our hospital because of relapse of acute myeloblastic leukemia (M2). Remission was successfully reinduced after reinduction chemotherapy consisting of daunorubicin, cytosine arabinoside, etoposide and vincristine, but was complicated by neutropenia. After the therapy, the patient had persistent fever of about 38 degrees C despite broad-spectrum antibiotics therapy and the patient developed pain in the right quadrant of the abdomen. The white blood cell count rose to 23000/mm3. Liver function tests showed abnormal findings mainly consisting of an elevated serum alkaline phosphatase level. Ultrasonography showed multiple hypoechoic lesions in the liver and CT scans also revealed multiple low density areas. Therefore he was suspected of having a complication of liver abscesses. Amphotericin B was administered 75 mg/day intravenously every other day. A percutaneous liver biopsy was performed, but was not diagnostic. Blood cultures were negative for pathogens. Amphotericin B was administered up to a cumulative dosage of 2.3 g, but the patient remained febrile. Then he had an exploratory laparotomy and an open liver biopsy. The liver biopsy samples showed fungal elements proved by PAS staining. A catheter was inserted into the portal vein. Administration of Amphotericin B was started 20 mg daily through the catheter. The temperature fell to normal after institution of this therapy. The abnormal findings in CT scans almost disappeared and the inflammatory findings became negative after he had received intraportal administration of Amphotericin B over three months. Through the analysis of this case study, we confirmed that the intraportal administration of Amphotericin B was effective to the intractable liver abscesses due to fungi.

Topics: Amphotericin B; Antineoplastic Combined Chemotherapy Protocols; Humans; Infusions, Intravenous; Leukemia, Myeloid, Acute; Liver Abscess; Male; Middle Aged; Mycoses; Neutropenia; Portal Vein; Remission Induction

A 36-year-old male with acute promyelocytic leukemia in second relapse was admitted to receive reinduction therapy in June, 1985, and entered into third complete remission, but he developed spiky fever after chemotherapy. Ultrasonic tomography revealed multiple liver abscesses and culture of the aspirates demonstrated Candida albicans in the abscesses. He was treated with intravenous administration of amphotericin B (AMPH-B) but the effect on the liver abscesses was unsatisfactory and consolidation therapy was difficult to start. AMPH-B (30 mg/day) was administered by percutaneous transhepatic intraportal administration (PTIA). About two months later, multiple liver abscesses disappeared. No remarkable complications such as severe fever, chill and renal dysfunction were recognized during PTIA of AMPH-B. So PTIA of AMPH-B is considered to be useful and safe for the management of fungal liver abscesses.

Topics: Adult; Amphotericin B; Candidiasis; Catheterization; Cytarabine; Humans; Leukemia, Promyelocytic, Acute; Liver Abscess; Male; Portal System

Topics: Administration, Oral; Adult; Aged; Amphotericin B; Bile; Female; Gallbladder; Humans; Liver; Liver Abscess; Male; Middle Aged; Mycoses; Premedication; Spleen; Tissue Distribution

A 39-year-old man with severe diabetes mellitus, chronic pancreatic insufficiency, intrapancreatic choledochal stricture, and secondary biliary cirrhosis developed postsurgical fungemia and large hepatic abscesses due to Torulopsis glabrata. These were treated successfully with a combination of amphotericin B and percutaneous drainage of the liver abscesses. We believe this is the first reported case of such infection due to this normally saprophytic agent.

Topics: Adult; Amphotericin B; Candidiasis; Combined Modality Therapy; Drainage; Humans; Liver Abscess; Male

Topics: Administration, Oral; Adult; Amphotericin B; Candidiasis; Female; Humans; Leukemia, Myeloid, Acute; Liver Abscess

Topics: Adult; Amphotericin B; Antineoplastic Combined Chemotherapy Protocols; Cytarabine; Daunorubicin; Humans; Leukemia, Myeloid, Acute; Liver Abscess; Male; Mercaptopurine; Portal System; Prednisolone

In an 18-month period candidal splenic abscesses were diagnosed and treated in eight patients. Predisposing factors consisted of recent exposure to cytotoxic chemotherapy, long-term use of prednisone, neutropenia, antibiotic therapy for greater than three weeks, and gastrointestinal tract colonization with Candida. The patients had a clinical profile of nontoxic appearance with a temperature of more than 38.5 degrees C that was unresponsive to antibiotics, pain and tenderness over the upper abdominal quadrants, focal defects visualized on ultrasound and/or computed tomographic scans, and an elevated alkaline phosphatase level. Candida infection was confirmed by histologic examination of the liver and/or spleen in all patients. Diagnosis was made by percutaneous biopsy in one patient and exploratory laparotomy in seven. Five patients had splenectomy and antifungal drugs. In three patients the fungal abscesses resolved with amphotericin B therapy alone. Seven of eight patients were cured of their splenic abscesses, and five of eight were long-term survivors.

Topics: Abscess; Adolescent; Adult; Amphotericin B; Candidiasis; Child, Preschool; Diagnosis, Differential; Female; Flucytosine; Follow-Up Studies; Humans; Immunosuppression Therapy; Liver Abscess; Male; Middle Aged; Splenic Diseases; Tomography, X-Ray Computed; Ultrasonography

We report two patients with chronic granulomatous disease (CGD) and life-threatening infections: a 10 10/12-year-old boy had Aspergillus fumigatus spondylitis with destruction of the 11th vertebral body and paravertebral abscess formation, and an 8 5/12-year-old boy had multiple Staphylococcus aureus hepatic abscesses with subphrenic abscess formation. Both patients failed to respond to intense antimicrobial therapy but showed a remarkable recovery following surgical drainage combined with granulocyte transfusions. These results suggest that antimicrobial therapy and surgical drainage followed by granulocyte transfusions may be the ideal mode of treatment for severe infections in patients with CGD.

Topics: Amphotericin B; Blood Transfusion; Child; Drug Combinations; Flucytosine; Granulocytes; Granulomatous Disease, Chronic; Humans; Liver Abscess; Male; Spondylitis; Staphylococcal Infections; Subphrenic Abscess; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Invasive fungal disease continues to be a significant problem among immunocompromised patients. We report a case of systemic Rhodotorula infection in a patient with acute myelogenous leukaemia. Rhodotorula was isolated from bone marrow on two separate occasions despite initial treatment with amphotericin B. Liver computerised tomographic scan suggested liver abscesses, and yeasts were seen on biopsy. The patient survived after aggressive antifungal and antileukaemia treatment. Rhodotorula fungaemia has been occasionally associated with shock. As our case illustrates, Rhodoturola may be a cause of invasive fungal disease in the immunocompromised host but can be eradicated if treated aggressively.

Topics: Adult; Amphotericin B; Bone Marrow; Flucytosine; Humans; Ketoconazole; Leukemia, Myeloid, Acute; Liver Abscess; Male; Mitosporic Fungi; Mycoses; Rhodotorula