Treatment of mucormycosis with liposomal Amphotericin B, posaconazole and deferasirox: A case report
Makaleler > Tam Makale · 2014
Yazarlar: O.R. Sipahi, U. Onal, Meltem TAŞBAKAN, Tansu YAMAZHAN, Bilgin ARDA, Hüsnü PULLUKÇU, S. Ulusoy
International Journal of Infectious Diseases, Uluslararası, Wos, 2014, cilt 21, ss 283-284
DOI: 10.1016/j.ijid.2014.03.1009
Özet
Background: In this report, we present a 69 years old diabetic patient with mucormycosis which was succesfully treated with liposomal Amphotericin B (LAMB), posaconazole and deferasirox. Methods & Materials: A 69 years old female patient with hypertension and type2 diabetes mellitus, admitted to hospital with complaints of diplopia, pain, edema and conjuctivitis on the right eye. Steroid treatment was started and she was referred to our setting because of total ophtalmoplegia on right eye. In addition to right eye chemosis and edema, eye movements were restricted in all directions with fix-dilated pupilla. Orbital computer tomography was interpreted as preorbital cellulitis. The patient was internalized in the ophthalmology department with piperacilin-tazobactam plus linezolid. After 5 days of treatment control MRI revealed a fungal infection which infiltrated all of the compartments of right eye, right cavernous sinüs plus occludes right internal carotid artery. After this, the patient was transferred to infectious diseases department with the diagnosis of mucormycosis. Piperacillin-tazobactam was switched to meropenem (1gr q8 h i.v.). Also, amphotericin B deoxycholate 1 mg/kg was started but due to allergic reaction, it was changed with LAMB (5 mg/kg/day). Ethmoidal and sphenoidal sinüs biopsies revealed mucormycosis in pathology. Results: The surgical debridement was not found applicable by surgical departments. The dose of LAMB was increased to 7 mg/kg/day on the 10th day of LAMB. After six days posaconazole (400 mg/day q12 h p.o.) was added due to no clinical improvement.and worsening of the patient's headache. Control Cranial MRI showed progression. Therefore LAMB dose was increased to 10 mg/kg/day and deferasirox was added (20 mg/kg/day p.o.) at the 15th day of treatment and contiunued for 14 days. After that, clinical findings and control cranial MRI stable when compared to previous MRI. On the 30th day of treatment LAMB dose was decreased to 7 mg/kg/day and meropenem plus linezolid treatment was stopped. The patient was discharged with posaconazole after 47 days of LAMB. There was no relapse on 3 month follow-up of the patient with posaconazole treatment which was given 2 months at all. Conclusion: Combination of antifungal antibiotics with deferasirox may be successful in the salvae tehrapy of mucormycosis.