We recently succeeded in eradicating a
Fusarium infection by treatment with
liposomal amphotericin B (
L-AmB). The patient, a 22-year-old man with acute lymphoblastic leukaemia (ALL), developed
fever and diffuse cutaneous maculopapular necrotising nodules during post-
chemotherapy neutropenia. Fusarium verticilloides was isolated from the skin, and hyphae were observed on direct microscopy. Despite increased WBC and
amphotericin B (AmB) treatment (0.7 mg/kg/day for 11 days), he remained febrile and a chest X-ray revealed pulmonary lesions.
Fusarium infection was confirmed by bronchial aspirate. AmB was increased to 1 mg/kg/day, and continued for 16 days (total dose 1630 mg). A slight improvement was observed at tomography, but nephrotoxicity developed. Treatment was changed to
L-AmB (3 mg/kg/day). The patient received this
drug for 20 days (total dose of 3850 mg) with complete regression of the pulmonary lesions. No adverse event occurred, and nephrotoxicity resolved. The patient was discharged from hospital cured of the
Fusarium infection and in clinical and haematological remission. No relapse of
fusariosis occurred, despite additional courses of intensive
chemotherapy.
Ambisome could represent an important advance in antifungal treatment since it allows aggressive treatment and eradication of
mycoses refractory to conventional
therapy while avoiding renal toxicity.