Successful Treatment of Disseminated Central Nervous Aspergillosis in a Patient with Acute Myeloblastic Leukemia

Abstract

Invasive opportunistic mycoses are common complications in patients suffering from hematological disorders. Brain abscesses in the immunocompromised host are known to be most frequently caused by fungi of the Aspergillus species and are often associated with concomitant pulmonary disease. As the penetration of the currently available antifungal agents into the brain tissue is limited, only very few patients have been described to survive this life-threatening condition. We report the case of a 62 year old female patient who presented with multiple aspergillus brain abscesses during prolonged neutropenia following induction chemotherapy for acute myeloblastic leukemia and was successfully treated with high dose (8 mg/kg/day) liposomal amphotericin B.

Review of comparative studies between conventional and liposomal amphotericin B (Ambisome®) in neutropenic patients with fever of unknown origin and patients with systemic mycosis

“…A similar percentage of patients in the 3 mg kg −1 group showed an increase in creatinine in comparison with about 50% of patients receiving conventional amphotericin B. Even higher dosages of AmBisome ® can be applied without an excessive increase in the rate of complication [ 20–31].…”

“…In comparison with conventional amphotericin B, which has an upper limit of tolerance at 1.5 mg kg −1 , the liposomal formulation offers advantages. A dose of 3 mg kg −1 is considered standard, although much higher regimens have been used in single patients [ 20–22] and recently published studies used even higher dosages [ 20–23]. Due to higher plasma levels and area under the curve‐data an increased barrier against systemic fungal infection could be achieved by treatment with liposomal ampho B compared to treatment with conventional ampho B [ 24].…”

Successful treatment of invasive mould infection affecting lung and brain in an adult suffering from acute leukaemia

“…However, several studies showed that AmBisome ® is comparable to amphotericin B deoxycholate in treating invasive mycosis (30, 31). The recommended dose in invasive mycosis ranges from 1 to 8 mg/kg/d (1, 3, 11, 17, 32). We administered 6 mg/kg/d AmBisome ® following most reports utilizing high doses of liposomal amphotericin B in invasive mycosis with brain involvement (1, 3, 14, 32).…”

“…The recommended dose in invasive mycosis ranges from 1 to 8 mg/kg/d (1, 3, 11, 17, 32). We administered 6 mg/kg/d AmBisome ® following most reports utilizing high doses of liposomal amphotericin B in invasive mycosis with brain involvement (1, 3, 14, 32). It was possible to successfully treat 4 immunosuppressed patients with cryptococcal meningitis by delivering a liposomal amphotericin B formulation in a daily dose of 4–6 mg/kg (14).…”

“…Invasive mycosis is common in immunocompromised patients suffering from acute leukaemia and is frequently caused by aspergillus (1, 2). Mortality in cases of brain involvement is up to 80–100% (3–6).…”