High dose liposomal amphotericin-B therapy for rhinocerebral mucormycosis

Abstract

The patient in this case was a 4.5 years old girl having been treated with modified BFM 90 protocol for high risk ALL. At the 38(th), day of the treatment, localiscd edema of the left side of her face and nasal septal inflammation and destruction were detected. At the computerized tomographic examination pansinusitis, destruction of the left orbital margin, invasion to intraorbital and paraseptal region and also hypodcnse areas of left temporal lobe were seen. Liposomal amphotericin B,with a dose of 1mg/kg per day was added to her wide spectrum antibiotic treatment. Necrosis and hyphae of mucormycosis had been seen in the pathological examination of the biopsy of the hard palate. After that, L- amphotericin B dose was increased to 8mg/kg per day. Necrotic tissue debridement was performed twice. At the 197(th) day of the high dose liposomal amphotericin B treatment, deterioration in the renal function tests were detected and the dose of the drug was decreased. Then the renal function tests returned to normal. At the 238(th) day drug was stopped due to the regeneration of the tissues at the lesion site. Reconstructive surgery was planned for future sequelas. As a result, amphotericin B treatment is accepted as a gold standard in the therapy.