amphotericin-b and Purpura--Thrombocytopenic--Idiopathic

Rhino-orbito-cerebral mucormycosis (ROCM) is a rare, fulminant opportunistic fungal infection that is mostly seen in immunocompromised or diabetic patients. The disease should be recognised and treated immediately. We present here MR imaging findings of two patients with histopathologically proven ROCM. One of the cases had a history of corticosteroid treatment and iatrogenic diabetes mellitus and although amphotericin B was started immediately, the disease progressed and surgical debridement was necessary. The second case was a patient with diabetes mellitus type 1 in whom ROCM had occurred following an abdominal surgery; amphotericin B treatment alone was adequate in this patient.

Topics: Adrenal Cortex Hormones; Amphotericin B; Antifungal Agents; Brain Diseases; Diabetes Complications; Diabetes Mellitus, Type 1; Humans; Iatrogenic Disease; Immunocompromised Host; Male; Middle Aged; Mucormycosis; Nose Diseases; Opportunistic Infections; Orbital Diseases; Purpura, Thrombocytopenic, Idiopathic

The authors report on a 14-year-old adolescent boy suffering of Hodgkin disease in remission, who developed autoimmune anemia and thrombopenia. He was treated with high-dose steroids and he developed serious invasive lung aspergillosis, which was treated with antifungal agents and surgical intervention. Children suffering from cancer are prone to develop systemic fungal infections secondary to the severe immunosuppression caused by the disease itself and the antineoplastic therapy. Intravenous antifungal medications and, when feasible, surgery are used for treatment of pulmonary aspergillosis. Factors related to better outcome are early diagnosis, remission of underlying disease, aggressive antifungal therapy, and recovery from neutropenia.

Topics: Adolescent; Amphotericin B; Anemia; Antifungal Agents; Antineoplastic Combined Chemotherapy Protocols; Aspergillosis, Allergic Bronchopulmonary; Bleomycin; Etoposide; Hodgkin Disease; Humans; Lung; Male; Prednisone; Purpura, Thrombocytopenic, Idiopathic; Radiography; Vinblastine

Topics: Absidia; Aged, 80 and over; Amphotericin B; Anemia, Hemolytic, Autoimmune; Antibodies, Monoclonal, Murine-Derived; Antifungal Agents; Combined Modality Therapy; Cryoglobulinemia; Cyclophosphamide; Debridement; Dexamethasone; Fatal Outcome; Female; Humans; Immunocompromised Host; Immunosuppressive Agents; Leukemia, Lymphocytic, Chronic, B-Cell; Liposomes; Mucormycosis; Purpura, Thrombocytopenic, Idiopathic; Rituximab

We report a fatal case of a rhino-cerebral zygomycosis, caused by Rhizopus arrhizus (oryzae). The patient was suffering from idiopathic thrombopenic purpura, diagnosed 1 year earlier. He was already treated with methylprednisolone 5 months prior to his admission to the hospital for a loss of vision and pain in the left eye as well as left orbital cellulitis. After an initial empirical treatment with broad spectrum antibiotics and voriconazole (infection of unknown origin), the patient was treated with liposomal amphotericin as soon as a positive fungal culture revealed a zygomycete. Unfortunately, the mould was resistant to amphotericin B (MIC: 16 microg ml(-1)) and probably to posaconazole (MIC: 4 microg ml(-1)), which was co-administrated a few days later.

Topics: Aged; Amphotericin B; Anti-Inflammatory Agents; Antifungal Agents; Central Nervous System Diseases; Drug Resistance, Fungal; Fatal Outcome; Humans; Male; Methylprednisolone; Purpura, Thrombocytopenic, Idiopathic; Pyrimidines; Rhinitis; Rhizopus; Triazoles; Voriconazole; Zygomycosis

Invasive aspergillosis is a devastating infection in immunocompromised hosts. The lung is the most common site of primary infection, and the central nervous system is the most common secondary site of invasive disease. Invasive aspergillosis in autoimmunopathies treated with corticosteroids has rarely been reported in the literature. Herein, we report the case of a 48-year-old female patient with idiopathic thrombocytopenic purpura complicated with fatal invasive pulmonary and cerebral aspergillosis. She had been given 1,016 g intravenous amphotericin B empirically for lung infection during a previous admission. At presentation, she had fever, cough, and shortness of breath for 4 weeks. Chest radiography revealed a huge cavity over the left upper lung field. Bronchoscopic biopsy and culture showed Aspergillus species. She was initially treated with intravenous amphotericin B (0.9 mg/kg/day), and intravenous hydrocortisone for her idiopathic thrombocytopenic purpura. However, deterioration of consciousness occurred 12 days after hospitalization. Computed tomography of the brain showed ring-like cystic mass lesions in the right side basal ganglion. Stereotactic aspiration of the brain revealed Aspergillus species. Her condition exacerbated despite combination treatment with high-dose amphotericin B (1.2 mg/kg/day) and itraconazole (400 mg/day). She died 24 days after admission. This case suggests that treatment with corticosteroids and premature discontinuation of antifungal drugs bear the risk of fatal cerebral involvement in patients with invasive pulmonary aspergillosis.

Topics: Amphotericin B; Antigens, Fungal; Aspergillosis; Brain Abscess; Drug Therapy, Combination; Female; Humans; Lung Diseases, Fungal; Middle Aged; Purpura, Thrombocytopenic, Idiopathic

A woman of 75 years old was admitted at our hospital for evaluation of worsening and weakness in inferior limbs. Several vertebral fractures by crushing, one doubtful discitis, an infiltrate with cavitation in the right superior lobe and one infiltrate in the left superior lobe were detected. In the biopsy of the consolidation a filamentous fungus was watched and in the bronchial washing specimen culture grew Aspergillus terreus. The infiltrates disappeared with liposomal Amphotericin B remaining with oral Itraconazol during three months more. The clinical and analytical data demonstrate the existence of a Overlap syndrome associate to antiphospholipid-antibody syndrome. We comment the peculiarity of the infection by Aspergillus terreus in patients who have not been in critical care and the good response at treatment with liposomal Amphotericin B. It contrasts with the high mortality referred in a recent review. Other aspects to comment are the coexistence with a collagen vascular and an antiphospholipid-antibody syndrome with the higher titles of IgM ACA that we have found in literature.

Topics: Aged; Amphotericin B; Antifungal Agents; Antiphospholipid Syndrome; Aspergillosis; Aspergillus; Autoimmune Diseases; Drug Therapy, Combination; Female; Gastritis, Atrophic; Helicobacter Infections; Humans; Immunocompromised Host; Immunosuppressive Agents; Itraconazole; Liposomes; Lung Diseases, Fungal; Opportunistic Infections; Prednisone; Purpura, Thrombocytopenic, Idiopathic