Rhinocerebral mucormycosis: Use of liposomal amphotericin B

Abstract

Rhinocerebral mucormycosis is a rare but often fatal condition characterized by an aggressive necrotizing infection spreading from the nose to the paranasal sinuses, orbit and hence to the central nervous system. A case is reported in which a diabetic male with advanced mucormycosis was successfully treated by a combination of surgery, supportive therapy and liposomal amphotericin B. Liposomal delivery allows the drug to be both less toxic and more effective, and this is the first reported case of its use in rhinocerebral mucormycosis.

Rhino-Orbital-Cerebral Mucormycosis With Different Cerebral Involvements: Infarct, Hemorrhage, and Ophthalmoplegia

“…The destruction of bony structures or vascular invasion, such as involvement of the cavernous sinus or thrombosis of the carotid artery, can also be seen. Intracerebral fungal involvement may appear on CT as low-density masses with variable peripheral enhancement or hypodense areas without a mass (Fisher et al, 1991).…”

Zygomycetes in Human Disease

“…Liposomal amphotericin B is indicated in patients with renal insufficiency (217). The liposomal form has different pharmacokinetics, allowing for higher dosing, higher efficacy, and reduced toxicity (161,360). No oral chemoprophylaxis has been recommended to prevent zygomycosis in cancer patients (154).…”

Indications for Orbital Exenteration in Mucormycosis

“…A liposomal encapsulate form of the drug called liposomal amphotericin B enhances the intracellular delivery of the drug to phagocytes and fungi, and it decreases its renal delivery. 11,12 The development of this drug carrier system has increased the therapeutic index of amphotericin B more than 20-fold. 11 Not enough data were available in the current study to make a definitive statement on the effectiveness of liposomal amphotericin B on patient survival.…”

“…11,12 The development of this drug carrier system has increased the therapeutic index of amphotericin B more than 20-fold. 11 Not enough data were available in the current study to make a definitive statement on the effectiveness of liposomal amphotericin B on patient survival. In the few published cases, all patients who were treated with liposomal amphotericin B survived.…”