Byungse Suh
Temple University School of Medicine, USA
Title: Treatment of Cerebral Mucormycosis with Prolonged Liposomal Amphotericin B (LAMB) (> 900 days)
Biography
Biography: Byungse Suh
Abstract
A 51 yom with COPD was hospitalized for pneumococcal pneumonia and sepsis requiring mechanical ventilation and glucocorticoid treatment for 30 days. One week later, he developed right hemiplegia and confusion. MRI of brain demonstrated two left parietal lesions with edema. A brain biopsy fungal stain showed non-septate, right angle branching hyphae consistent with mucormycosis; fungal culture was negative. Treatment was initiated with high dose LAMB (10 mg/kg/day), and by day 9 the patient showed improvement in mentation and the ability to lift his right arm. LAMB was decreased (5 mg/kg) and oral posaconazole (PCZ) (400 mg BID) was added. He continued to improve and was discharged on this combination therapy (day 28). On day 38, chemical hepatitis was observed, presumably due to PCZ. PCZ was discontinued while continuing LAMB. On day 51, PCZ was re-introduced in an attempt to convert to oral therapy. On day 166, LAMB was discontinued; PCZ was continued alone. He was readmitted with another episode of pneumonia (day 221) and repeat MRI demonstrated significant enlargement of the known parietal lesions and a new enhancing right parietal lesion. PCZ was discontinued and LAMB was restarted (day 229). On day 541, LAMB was discontinued due to acute renal failure and PCZ was reintroduced. On day 576, LAMB was resumed due to progression of brain lesions while on posaconazole. The patient was continued on LAMB until day 978 when he expired due to respiratory failure. In this patient, LAMB appeared more efficacious in controlling cerebral mucormycosis than posaconazole.