Case 1. A 34-year-old male was admitted in July, 1986 with a diagnosis of AML (M2). Two courses of BHAC-DMP regimen induced complete remission in October, while marked
pyrexia resistant to
antibiotics remained. An ultrasonography (US) and computed tomography (CT) revealed multiple liver and spleen
abscesses suspected of mycotic etiology. Administration of
amphotericin B (AMPH-B) by
intravenous injection was difficult owing to its severe side effect. Multiple
abscesses increased in the size and number despite treatment with
Miconazole (MCZ) and
Ketoconazole. Exploratory
laparotomy was performed with
splenectomy, and splenic specimens were found to contain Candida organisms. Soon AMPH-B was administered through a
catheter inserted into the portal vein at the same time. A side effect by AMPH-B was tolerable and his
fever resolved to normal in 2 weeks after institution of this
therapy, and the sizes of
abscesses were markedly reduced. The patient remained in remission through 23 months, free of
fungal infection. Case 2. A 23-year-old female was admitted for relapse of ALL (L2), in April, 1987. Reinduction
therapy with BHAC-L-AVP achieved again in May but
fever unresponsive to
antibiotics occurred. Since multiple liver-spleen
abscesses were showed by US and CT suspected mycotic etiology, antimycotic
therapy with
Miconazole and AMPH-B was performed but clinical findings were deteriorated. AMPH-B was administered through a
catheter inserted into the hepatic artery for two weeks, following into the splenic artery for a week. Splenic
abscesses were resolved in a week and
liver abscesses were markedly reduced at three weeks after initiation of intra-arterial antifungal treatment. Through the analysis of these case studies we confirmed the usefulness of intraportal and intrahepatosplenic arterial administration of AMPH-B.