amphotericin-b and Liver-Failure--Acute

Talaromyces marneffei infection is an important opportunistic infection associated with acquired immune deficiency syndrome (AIDS). However, it is unusual in patients with non-AIDS and other non-immunosuppressed conditions. We report a case of delayed diagnosis of disseminated T. marneffei infection in non-AIDS, non-immunosuppressive and non-endemic conditions.. Early diagnosis in HIV-negative patients who are otherwise not immunosuppressed and endemic poses a serious challenge. T. marneffei infection is an FDG-avid nonmalignant condition that may lead to false-positive FDG PET/CT scans. Nevertheless, integrated FDG PET/CT is necessary in patients with fever of unknown origin in the early period to perform earlier biopsy for histopathology and culture in highly avid sites and to avoid delays in diagnosis and treatment.

Topics: AIDS-Related Opportunistic Infections; Amphotericin B; Antifungal Agents; China; Delayed Diagnosis; Diagnosis, Differential; Fatal Outcome; Fever; High-Throughput Nucleotide Sequencing; HIV; Humans; Liver Failure, Acute; Lymphoma; Male; Mycoses; Positron Emission Tomography Computed Tomography; Talaromyces; Tomography, X-Ray Computed; Young Adult

Leishmaniasis is an emerging infectious disease. Due to human migration and tourism, visceral leishmaniasis may become more common in non-endemic areas. In the Mediterranean basin, visceral leishmaniasis typically occurs in rural regions.. We present an unusual urban case of acute liver failure due to visceral leishmaniasis, following a prolonged fever of unknown origin. After obtaining negative results from the bone marrow aspirate, we performed a liver biopsy that elucidated the diagnosis. The liver involvement in visceral leishmaniasis may appear as chronic granulomatous hepatitis. However diffuse hepatitis process, a necro-inflammatory pattern, without forming granulomas were observed in the liver biopsy specimens in this case. Intracytoplasmic Leishmania amastigotes were observed in the liver biopsy specimens and a polymerase chain reaction confirmed the diagnosis. Only five pathological confirmed cases of acute hepatitis due to visceral leishmaniasis have been described so far, just two in adults and both from Barcelona. A revision of the literature is performed.. Acute hepatitis is an uncommon debut of visceral leishmaniasis in immunocompetent patients. Furthermore there are only few cases in the literature that describe the histopathological changes that we found in this patient. In conclusion, in case of acute hepatitis leading to liver failure, leishmaniasis should be considered a differential diagnosis (even in non-endemic countries and without clear epidemiological exposure) and liver biopsy can elucidate the diagnosis.

Topics: Amphotericin B; Antiprotozoal Agents; Biopsy; Diagnosis, Differential; Fever; Hepatitis; Humans; Leishmaniasis, Visceral; Liver Failure, Acute; Male; Middle Aged; Polymerase Chain Reaction

Topics: Amphotericin B; Antifungal Agents; Biopsy; Debridement; Fatal Outcome; Female; Hemochromatosis; Hepatic Encephalopathy; Humans; Intubation, Gastrointestinal; Liver; Liver Failure, Acute; Middle Aged; Mucormycosis; Necrosis; Nose; Nose Diseases; Opportunistic Infections; Triazoles

Invasive fungal infection continues to pose a significant threat to immunocompromised patients, with cerebral aspergillosis being among the most feared ones. The authors describe an adolescent girl with acute lymphoblastic leukemia (ALL) with subsequent acute liver failure, who developed an aspergillus brain abscess. The patient was treated with combined antifungal therapy using amphotericin B local instillation, prolonged systemic amphotericin B colloidal dispersion along with vinca alkaloids-containing chemotherapy, followed by neurosurgical débridement and oral voriconazole in the setting of ongoing antileukemic maintenance chemotherapy. Her ALL remains now in complete remission 30 months from diagnosis, with no evidence of fungal infection.

Topics: Adolescent; Amphotericin B; Antifungal Agents; Antineoplastic Combined Chemotherapy Protocols; Aspergillosis; Brain Abscess; Combined Modality Therapy; Drug Therapy, Combination; Female; Humans; Liver Failure, Acute; Magnetic Resonance Imaging; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Pyrimidines; Remission Induction; Triazoles; Voriconazole