amphotericin-b and Lymphoma--Large-B-Cell--Diffuse

We report a case of

Topics: Adenine; Aged; Amphotericin B; Antibodies, Monoclonal, Murine-Derived; Antifungal Agents; Antineoplastic Combined Chemotherapy Protocols; Cryptococcosis; Cryptococcus neoformans; Cyclophosphamide; Doxorubicin; Empyema, Pleural; Fluconazole; Humans; Lymphoma, Large B-Cell, Diffuse; Male; Piperidines; Prednisone; Pyrazoles; Pyrimidines; Rituximab; Vincristine

Despite the relative high frequency of Candida bloodstream infection, Candida endocarditis is a rare entity. We report five cases of Candida endocarditis admitted to our hospital in the period between 2005 and 2011. Two cases were caused by C. albicans, two cases were caused by C. parapsilosis and in the last one, we didn't identify the species of Candida. All but one had clear risk factors for candidemia. Treatment consisted of amphotericin B with / without flucytosine in four patients, and they all underwent surgery for valve replacement and / or removal of intravascular devices. Overall mortality was 60% (40% of mortality was directly related to endocarditis). All patients who survived were given suppressive therapy with fluconazole for a minimum of two years.After stopping fluconazole there was a case of recurrence.

Topics: Acute Kidney Injury; Adult; Aged; Amphotericin B; Anti-Bacterial Agents; Antifungal Agents; Bacterial Infections; Candida; Candidiasis; Carcinoma, Transitional Cell; Combined Modality Therapy; Disease Susceptibility; Drug Therapy, Combination; Endocarditis; Fatal Outcome; Female; Fluconazole; Heart Valve Diseases; Heart Valve Prosthesis Implantation; Humans; Immunosuppressive Agents; Lymphoma, Large B-Cell, Diffuse; Male; Middle Aged; Pacemaker, Artificial; Postoperative Complications; Pregnancy; Pregnancy Complications, Infectious; Rheumatic Heart Disease; Sjogren's Syndrome; Spain; Tertiary Care Centers; Urinary Bladder Neoplasms

Zygomycosis is an opportunistic fungal infection that is increasingly reported in hematological patients. We describe 2 cases of successfully treated rhino-cerebral zygomycosis and give an overview of 120 patients from the literature with underlying hematological or oncological disorders. These data document the improved survival in sinus (15/17 patients surviving) and cutaneous (6/9 patients surviving) disease. Hematological patients with pulmonary (9/30 patients surviving) or disseminated (4/38 patients surviving) zygomycosis still have a poor prognosis. The clinical course of sinus-orbital involvement (4/11 patients surviving) follows sinus-cerebral (2/3 patients surviving) or cerebral (3/6 patients surviving) disease. Besides deoxycholate amphotericin B (AmB) (24/62 patients surviving), patients seem to benefit from liposomal amphotericin B (L-AmB) (10/16 patients surviving) or sequential AmB/L-AmB treatment (6/8 patients surviving). Alternative treatment options lead only in a few patients to success.

Topics: Adult; Aged; Amphotericin B; Antifungal Agents; Antineoplastic Combined Chemotherapy Protocols; Aspergillosis; Aspergillus fumigatus; Combined Modality Therapy; Deoxycholic Acid; Ethmoid Sinusitis; Female; Hematologic Diseases; Humans; Immunocompromised Host; Itraconazole; Ketoconazole; Liposomes; Lymphoma, Large B-Cell, Diffuse; Male; Maxillary Sinusitis; Middle Aged; Mucor; Mucormycosis; Multiple Myeloma; Nose Diseases; Opportunistic Infections; Prognosis; Treatment Outcome; Zygomycosis

Topics: Aged; Amphotericin B; Antifungal Agents; Bone Marrow; Cell Transformation, Neoplastic; Histoplasmosis; Humans; Itraconazole; Leukemia, Lymphocytic, Chronic, B-Cell; Liver; Lymph Nodes; Lymphoma, Large B-Cell, Diffuse; Male; Radionuclide Imaging; Spleen; Treatment Outcome

Clinicians have usually considered malignancies during follow up of patients who have infectious diseases as a pre-diagnosis. However, malignancy and an infectious disease are seen together more rarely, with the exception of immunosuppressed patients. This presentation is a case report followed up for fever of unknown origin. The patient was admitted to the hospital with the symptoms of fever, weight loss, abdominal pain and weakness. Anemia and hypergamaglobulinemia by biochemical analyses and splenomegaly by total body computed tomography were detected. Amastigotes were seen in bone marrow aspiration smears and promastigotes were isolated in NNN medium. At the end of the Liposomal Amphotericin B treatment, control bone marrow aspiration was applied. Leishmania amastigotes were not seen, while patient was diagnosed as diffuse B cell lymphoma pathologically.

Topics: Abdominal Pain; Amphotericin B; Anemia; Anticestodal Agents; Bone Marrow; Female; Fever of Unknown Origin; Humans; Hypergammaglobulinemia; Leishmania; Leishmaniasis, Visceral; Lymphoma, Large B-Cell, Diffuse; Middle Aged; Splenomegaly; Tomography, X-Ray Computed; Weight Loss

Topics: Acute Disease; Adult; Amphotericin B; Antifungal Agents; Appendicitis; Candidiasis; Female; Fluconazole; Humans; Leukemia, Myeloid, Acute; Liver Diseases; Lymphoma, Large B-Cell, Diffuse; Middle Aged; Splenic Diseases

Primary invasive mold infection of the oral cavity is a rare but serious complication in immunocompromised hosts. We report a case of fatal Trichoderma longibrachiatum stomatitis in a 66-year-old female patient with malignant lymphoma. The infection rapidly disseminated from the oral mucosa to the lungs during neutropenia. Despite intensive antifungal therapy with amphotericin B and itraconazole, there was a fatal progression of the condition. While Trichoderma species have been recognized to be pathogenic in profoundly immunosuppressed hosts, this is the first report of the primary oral focus causing a fatal infection.

Topics: Aged; Amphotericin B; Antifungal Agents; Disease Progression; Fatal Outcome; Female; Gingivitis, Necrotizing Ulcerative; Humans; Immunocompromised Host; Itraconazole; Lung Diseases, Fungal; Lymphoma, B-Cell; Lymphoma, Large B-Cell, Diffuse; Mycoses; Neutropenia; Opportunistic Infections; Stomatitis; Trichoderma

A 60-year-old man with a 9-year history of malignant lymphoma developed an initial pulmonary infection with Nocardia asteroides which later disseminated to the central nervous system with multiple brain abscesses. He was treated successfully with intravenous trimethoprim-sulfamethoxazole for 6 weeks. A follow-up computed tomography (CT) scan showed complete resolution of the abscesses. Two years later, he returned to the hospital with a 2-week history of confusion, loss of concentration, ataxia, and leaning to the left. A CT scan revealed an enhancing multiloculated complex right frontal lesion. Craniotomy revealed a large right frontal lobe abscess, which was totally resected. Histopathologic examination of the resected tissue revealed multiple, lightly pigmented, septate, branched hyphal elements typical of phaeohyphomycosis. The fungal isolate cultured from the tissue was a dematiaceous, thermotolerant fungus that was identified as Ochroconis gallopavum. Despite treatment with amphotericin B, flucytosine and fluconazole, the patient gradually deteriorated and died. This case represents the third fatal infection, the second from the southeastern United States, due to O. gallopavum.

Topics: Amphotericin B; Brain; Brain Abscess; Fluconazole; Flucytosine; Humans; Lymphoma, Large B-Cell, Diffuse; Male; Middle Aged; Mitosporic Fungi; Mycoses; United States

The clinical and pathological findings in 46 patients with cryptococcosis at Memorial Sloan-Kettering Cancer Center from 1956 to 1972 are reported. The striking predilection for cryptococcal infection in patients with leukemias and lymphomas is again confirmed. Of 41 patients with neoplastic disease, those with chronic lymphatic leukemia (CLL), Hodgkin's Disease, chronic myelogenous leukemia (CML), myeloma and lymphosarcoma had the highest incidence of cryptococcosis. In all cases, neoplastic disease was widespread when infection occurred. All of these patients had leukopenia and absolute lymphopenia at the time of infection. Thirty-nine were on steroids. Thirty-one patients with neoplastic disease had disseminated infection. Review of pathology revealed a spectrum of inflammatory lesions. Histiocytic-lymphocytic infiltrates occurred in the central nervous system in 10 patients. In six cases, reaction was granulomatous. There were single instances of suppurative and fibrotic reactions. Mortality from infection was high in patients with neoplastic disease. Twenty-four of 28 deaths occurred within 60 days as a result of infection. Within one year, 10 more patients died, nine of cryptococcosis. Only three survived more than one year, and all patients died within 600 days. Twenty-nine patients with neoplastic disease received amphotericin B. Only nine survived more than 60 days.

Topics: Amphotericin B; Antigens, Bacterial; Central Nervous System; Cryptococcosis; Cryptococcus neoformans; Female; Hodgkin Disease; Humans; Leukemia, Lymphoid; Leukemia, Myeloid; Lung; Lymphoma, Large B-Cell, Diffuse; Male; Multiple Myeloma; Neoplasms

Topics: Adrenocorticotropic Hormone; Amphotericin B; Blood Transfusion; Bone Marrow Examination; Drug Therapy; England; Geriatrics; Histoplasmosis; Lymphoma, Large B-Cell, Diffuse; Lymphoma, Non-Hodgkin; Neoplasms; Pathology; Prednisolone; Sarcoma; Toxicology

Topics: Amphotericin B; Anti-Bacterial Agents; Antineoplastic Agents; Candidiasis; Drug Therapy; Esophagoscopy; Esophagus; Hodgkin Disease; Humans; Leukemia; Leukemia, Lymphoid; Leukemia, Myeloid; Lymphoma, Large B-Cell, Diffuse; Lymphoma, Non-Hodgkin; Multiple Myeloma; Neoplasms; Sarcoma