RHINOCEREBRAL MUCORMYCOSIS TREATED WITH AMPHOTERICIN-B COLLOIDAL DISPERSION IN 3 PATIENTS

Rhinocerebral mucormycosis (zygomycosis) primarily affects diabetic or immunosuppressed patients and typically progresses rapidly, necessita ting surgical excision and antifungal therapy with amphotericin B. Lar ge doses of amphotericin B are required for cure, causing significant renal toxicity. Amphotericin B colloidal dispersion (ABCD; Amphocil, S equus Pharmaceuticals, Menlo Park, CA) is a 1:1 complex of cholesteryl sulfate and amphotericin B, which results in significant reduction of toxicity, especially nephrototoxicity. We describe three patients wit h life-threatening rhinocerebral mucormycosis treated with ABCD. All p atients had high serum creatinine levels due to prior treatment with a mphotericin B; these levels reverted to normal during treatment with A BCD. Two patients with diabetes mellitus were cured after receiving a combination of surgery and ABCD therapy. The third patient, who had my elodysplastic 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 des cription of the treatment of mucormycosis with ABCD.