DISSEMINATED VISCERAL FUSARIOSIS TREATED WITH AMPHOTERICIN-B-PHOSPHOLIPID COMPLEX

Fusariosis, a rare infectious disease of the immunocompromised host, i s relatively resistant to amphotericin B (AmB) or other antifungal age nts. We describe a 5-year follow-up of a 40 year old woman with T-type acute lymphoblastic leukemia who following chemotherapy developed pro longed high fever, chills, night sweats, and severe weakness. Liver fu nction tests were impaired and abdominal computerized tomography (CT) showed multiple lesions in the liver and abnormal structure of the spl een. A laparotomy revealed multiple granulomas containing Fusarium sp. in the liver, and the spleen was heavily infiltrated by the same fung us. The patient failed to respond to the conventional AmB dosage form (Fungizone) even after a total dose of 3.0 g was given, and developed significant renal impairment. AmB was complexed (in a mole ratio of 1: 16) with a mixture of the phospholipids dimyristoyl phosphatidylcholin e and dimyristoyl phosphatidylglycerol (mixed in 7:3 mole ratio). The resulting drug complex, AmB-PLC, was then administered (1-4 mg/kg/day, total dose 4.2 g) and subsequently the patient was cured of all sympt oms of fusariosis. There were only mild side effects and no nephrotoxi city was evident. On the contrary, marked improvement of the renal fun ction tests occurred during AmB-PLC treatment. Eight months later, she developed a spinal lesion with dense consistency in L5 and S1, and af ter receiving another course of AmB-PLC (3.1 g) she recovered complete ly. In a 2 year follow-up period the patient had no further relapse of the fungal disease. Subsequent chemotheraphy given for relapse of the leukemia was followed by a new fungal infection, which was treated wi th AmB-cholesteryl sulfate complex (Amphocil(TM)). The patient receiv ed 13.0 g Amb as Amphocil and fully recovered from the fungal infectio n. This case report suggests that when Fungizone is nephrotoxic and do es not permit efficacious antifungal treatment, AmB complexed with sui table lipids may be safe efficacious therapy.