Rhinocerebral mucormycosis treated with amphotericin B colloidal dispersion in three patients

Clin Infect Dis. 1998 Jun;26(6):1430-3. doi: 10.1086/516349.

Abstract

Rhinocerebral mucormycosis (zygomycosis) primarily affects diabetic or immunosuppressed patients and typically progresses rapidly, necessitating surgical excision and antifungal therapy with amphotericin B. Large doses of amphotericin B are required for cure, causing significant renal toxicity. Amphotericin B colloidal dispersion (ABCD; Amphocil, Sequus Pharmaceuticals, Menlo Park, CA) is a 1:1 complex of cholesteryl sulfate and amphotericin B, which results in significant reduction of toxicity, especially nephrotoxicity. We describe three patients with life-threatening rhinocerebral mucormycosis treated with ABCD. All patients had high serum creatinine levels due to prior treatment with amphotericin B; these levels reverted to normal during treatment with ABCD. Two patients with diabetes mellitus were cured after receiving a combination of surgery and ABCD therapy. The third patient, who had myelodysplastic syndrome, had an initial good response, with cure of the fungal infection; however, he eventually died of his primary illness. To the best of our knowledge, this is the first detailed clinical description of the treatment of mucormycosis with ABCD.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Aged
  • Amphotericin B / administration & dosage
  • Amphotericin B / adverse effects
  • Amphotericin B / therapeutic use*
  • Antifungal Agents / administration & dosage
  • Antifungal Agents / adverse effects
  • Antifungal Agents / therapeutic use*
  • Creatinine / blood
  • Female
  • Humans
  • Male
  • Middle Aged
  • Mucormycosis / drug therapy*
  • Opportunistic Infections / drug therapy
  • Paranasal Sinus Diseases / drug therapy*
  • Paranasal Sinus Diseases / microbiology

Substances

  • Antifungal Agents
  • Amphotericin B
  • Creatinine