Treatment of Invasive Fungal Sinusitis with Liposomal
Amphotericin B : A Report of Four Cases
SOMNUEK SUNGKANUPARPH, M.D.*, BOONMEE SATHAPATAYA VONGS, M.D.*,
SOMYOS KUNACHAK, M.D.**, THONGCHAI LUXAMEECHANPORN, M.D.**,
WI CHIT CHEEWARUANGROJ, M.D.**
Affiliation : * Department of Medicine,
** Department of Otolaryngology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10400,
Thailand.
AbstractInvasive fungal sinusitis increasingly causes significant morbidity and mortality in immu
nocompromised patients. It is difficult to treat. Despite standard treatment by surgical debridement
and intravenous amphotericin B, morbidity and mortality remain high. Conventional amphotericin
B is the standard drug but its use is limited by dose-related nephrotoxicity and infusion-related
acute toxicity. Liposomal amphotericin B has proven to be as effective as conventional ampho
tericin B with less nephrotoxicity and infusion reaction. We report four cases of invasive fungal
sinusitis who were treated with liposomal amphotericin B after having severe side effects from
conventional amphotericin B. There were two cases of mucormycosis and two cases of aspergil
losis. All patients had diabetes millitus. One patient had systemic lupus erythematosus and another
was receiving immunosuppressive drugs after kidney transplantation. All cases needed multiple
operations for sinus surgery. Two cases had acute reaction to amphotericin B infusion, one had
active lupus nephritis with renal insufficiency, and one was considered treatment failure from
amphotericin B. The patients received liposomal amphotericin B at the total doses of 4.55-8.85 g.
Two cases of mucormycosis were considered to be successfully treated. In cases of aspergillosis,
one was considered improved and another one with immunocompromised status died with active
disease. From our experience, surgery is the main treatment for patients with invasive fungal
sinusitis and liposomal amphotericin B is an effective alternative drug for adjuvant medical treat
ment. However, the degree of immunosuppression of the patients, the extension of fungal sinusitis
and perhaps the species of fungus are important factors determining the clinical response.
Keywords : Invasive Fungal Sinusitis, Liposomal Amphotericin B, Treatment
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