amphotericin-b and Rupture--Spontaneous

Systemic infection with Aspergillus fumigatus is an opportunistic disease that affects mainly immunocompromised hosts and is associated with a high mortality rate. We report a case of A. fumigatus endocarditis after an episode of thrombotic thrombocytopenic purpura. Diagnosis was established after sudden rupture of posterior papillary muscle of the normal native mitral valve. Soon after mitral valve replacement, Aspergillus endocarditis recurred, associated with multiple peripheral emboli, which necessitated a second operation.

Topics: Amphotericin B; Anti-Infective Agents; Aspergillosis; Aspergillus fumigatus; Candidiasis; Drug Resistance, Fungal; Embolism; Endocarditis; Fatal Outcome; Female; Heart Valve Prosthesis Implantation; Humans; Immunocompromised Host; Immunosuppressive Agents; Itraconazole; Lung Diseases, Fungal; Middle Aged; Mitral Valve Insufficiency; Opportunistic Infections; Papillary Muscles; Postoperative Complications; Prednisolone; Pseudomonas Infections; Purpura, Thrombotic Thrombocytopenic; Recurrence; Rupture, Spontaneous; Shock, Septic; Sputum; Ultrasonography; Urinary Tract Infections

A 44-year-old woman who underwent haploidentical stem cell transplantation (haplo SCT) for chronic myeloid leukemia in blast crisis and aspergillosis was admitted to the emergency room 7 months later because of severe right upper quadrant abdominal pain, fever, leukocytosis and peritoneal signs. Computer tomography disclosed cholecystitis and gallbladder perforation. Within hours, she underwent urgent open laparatomy and cholecystectomy. The postoperative period was uneventful and she was discharged 10 days later without any complications. Currently, she is 2(1/2) years posttransplantation in full hematological, cytogenetic and molecular remission with 100% Karnofsky performance status. Most notably, normal and fast recovery was observed following major surgery 7 months post-haplo SCT which is usually considered to result in long-lasting immunosuppression and malfunction of the immune system.

Topics: Adult; Alemtuzumab; Amphotericin B; Antibodies, Monoclonal; Antibodies, Monoclonal, Humanized; Antibodies, Neoplasm; Antifungal Agents; Aspergillosis; Blast Crisis; Cholecystectomy, Laparoscopic; Cholecystitis; Female; Gallbladder Diseases; Graft vs Host Disease; Graft vs Leukemia Effect; Haplotypes; Hematopoietic Stem Cell Transplantation; Histocompatibility; Humans; Immunocompromised Host; Leukemia, Myelogenous, Chronic, BCR-ABL Positive; Lung Diseases, Fungal; Lymphocyte Depletion; Rupture, Spontaneous; Staphylococcal Infections; T-Lymphocytes; Transplantation Chimera; Transplantation Conditioning; Transplantation, Homologous

Topics: Abdominal Abscess; Amphotericin B; Antifungal Agents; Candida; Candida albicans; Candida tropicalis; Candidiasis; Child, Preschool; Digestive System Surgical Procedures; Female; Fluconazole; Gastrins; Humans; Peritonitis; Reoperation; Rupture, Spontaneous; Stomach Rupture; Treatment Outcome

Fungal cells were observed infiltrating the submucosal margins of an acutely perforated gastric ulceration in an apparently immunocompetent 3-year-old girl. Perforation had occurred 24 h after hospital admission because of pain and vomiting. Colonies of Candida tropicalis were grown from peritoneal fluid and blood cultures. After surgical repair and a 30-day treatment with amphotericin B at a daily dose of 1 mg kg-1 body weight, the child was discharged in good health. No further infections have occurred in the 3 years since treatment.

Topics: Amphotericin B; Antifungal Agents; Candidiasis; Child, Preschool; Emergency Service, Hospital; Female; Humans; Immunocompetence; Male; Pain; Rupture, Spontaneous; Stomach Rupture; Stomach Ulcer; Vomiting

Topics: Aged; Amphotericin B; Candida; Candidiasis; Drainage; Female; Fluconazole; Humans; Pancreatic Pseudocyst; Rupture, Spontaneous

Candidal endocarditis can develop if candidemia occurs during Swan-Ganz catheterization. Candida endocarditis may persist for many months and is fatal unless the infected valve is resected. Herein is reported the first case of rupture of a mycotic pulmonary artery aneurysm caused by chronic candidal endocarditis. The endocarditis followed Swan-Ganz catheterization and aneurysm progressed despite appropriate medical and surgical therapy.

Topics: Amphotericin B; Aneurysm, Infected; Candidiasis; Catheterization, Swan-Ganz; Endocarditis; Humans; Male; Middle Aged; Pulmonary Artery; Rupture, Spontaneous; Time Factors