Prompt Resolution of Nasal Aspergillosis with Intra-Nasal Instillation of Liposomal Amphotericin-B (Ambisome ® ) and Granulocyte Transfusions.

Visceral fungal infections are a serious complication during chemotherapy in acute myeloid leukemia patients. In particular, aspergillus species are often responsible for severe infections in these patients. The lung, with at least four different histo-pathological patterns, and the nasal sinuses are the sites most frequently involved by this agent. Both types of infection can be lethal, the invasion of major bronchial vessels, and the colonisation of the central nervous system through the ethmoid bone both possible dramatic events. Recovery of ANC and prompt systemic specific antifungal treatments are then necessary in order to control the process. At present, intravenous deoxicholate amphotericin B (fungizoneB) is the most frequently employed schedule for the treatment of these infections, and nephrotoxicity and infusion related chills are the principal adverse effects. These two drugs have also been tested as an aerosol in order to increase the pulmonary concentration and reduce their systemic toxicity. Moreover, the successful direct instillation of antifungal agents into a pulmonary aspergillus has been described. In some cases, lung surgery can be proposed for isolated aspergillomas, while granulocyte transfusions have also been utilised in case of invasive mycosis.