암포테리신, 포사코나졸 병용투여와 암포테리신 세척으로 치료한 비안와두부형 국균증 1예

다국어 초록 (Multilingual Abstract)

Purpose: To report a case of rhino-orbito-cerebral aspergillosis successfully treated with a combination of amphotericin B, posaconazole and amphotericin B irrigation.
Case summary: A 59-year-old male with hypertension, diabetes mellitus and hyperlipidemia was admitted to our neurology department for left facial paresthesia, pain and consulted to ophthalmology for left eyeball pain. His visual acuity was no light perception in the left eye, and fundus examination showed papilledema and a cherry-red spot. Left exophthalmos and complete ptosis with ophthalmoplegia were also observed. Orbital computed tomography revealed left maxillary and ethmoid sinusitis, and nasal endoscopic examination revealed a black eschar adjacent to the middle turbinate. Subsequent biopsy suggested mucormycosis. The patient was immediately treated with a combination of amphotericin B and posaconazole. In addition, left endoscopic sinus surgery was performed and aspergillosis was histopathologically confirmed. The patient underwent amphotericin B irrigation for 5 days after canula insertion up to orbital apex. The patient survived for 18 months and is still alive.
Conclusions: A combination of amphotericin B, posaconazole and amphotericin B irrigation using the canula through the orbital apex may be helpful in treating patients with rhino-orbito-cerebral aspergillosis who refuse orbital exenteration.

참고문헌 (Reference)

1 임선희, "안와 및 두개내로 파급된 침윤성 국균증: 보리코나졸로 치료한 1예" 대한안과학회 54 (54): 540-544, 2013

2 Herbrecht R, "Voriconazole versus amphotericin B for primary therapy of invasive aspergillosis" 347 : 408-415, 2002

3 Zuniga MG, "Treatment outcomes in acute invasive fungal rhinosinusitis" 22 : 242-248, 2014

4 Mahomed S, "The successful use of amphotericin B followed by oral posaconazole in a rare case of invasive fungal sinusitis caused by co-infection with mucormycosis and aspergillus" 2 : 116-117, 2015

5 Levin LA, "The spectrum of orbital aspergillosis:a clinicopathological review" 41 : 142-154, 1996

6 Seiff SR, "Role of local amphotericin B therapy for sino-orbital fungal infections" 15 : 28-31, 1999

7 Arndt S, "Rhino-orbital-cerebral mucormycosis and aspergillosis: differential diagnosis and treatment" 266 : 71-76, 2009

8 Wakabayashi T, "Retrobulbar amphotericin B injections for treatment of invasive sino-orbital aspergillosis" 51 : 309-311, 2007

9 Cho HJ, "Prognostic factors for survival in patients with acute invasive fungal rhinosinusitis" 29 : 48-53, 2015

10 Foster CS, "Ocular toxicity of topical antifungal agents" 99 : 1081-1084, 1981

11 Arora V, "Nagarkar NM" 63 : 325-329, 2011

12 Kusaka K, "Long term survival of patient with invasive aspergillosis involving orbit, paranasal sinus, and central nervous system" 87 : 791-792, 2003

13 Sivak-Callcott JA, "Localised invasive sino-orbital aspergillosis: characteristic features" 88 : 681-687, 2004

14 Walsh TJ, "Liposomal amphotericin B for empirical therapy in patients with persistent fever and neutropenia. National Institute of Allergy and Infectious Diseases Mycoses Study Group" 340 : 764-771, 1999

15 Dhiwakar M, "Invasive sino-orbital aspergillosis:surgical decisions and dilemmas" 117 : 280-285, 2003

16 Trief D, "Invasive fungal disease of the sinus and orbit: a comparison between mucormycosis and Aspergillus" 100 : 184-188, 2016

17 Rickerts V, "Diagnosis of invasive aspergillosis and mucormycosis in immunocompromised patients by seminested PCR assay of tissue samples" 25 : 8-13, 2006

18 Dökmetaş HS, "Diabetic ketoacidosis and rhino-orbital mucormycosis" 57 : 139-142, 2002

19 Torres-Damas W, "Coinfection of rhinocerebral mucormycosis and sinus aspergillosis" 32 : 813-817, 2015

20 Choi HS, "Clinical characteristics and prognosis of orbital invasive aspergillosis" 24 : 454-459, 2008

21 Walsh TJ, "Amphotericin B lipid complex for invasive fungal infections: analysis of safety and efficacy in 556 cases" 26 : 1383-1396, 1998

22 Diekema DJ, "Activities of caspofungin, itraconazole, posaconazole, ravuconazole, voriconazole, and amphotericin B against 448 recent clinical isolates of filamentous fungi" 41 : 3623-3626, 2003