Vol.69 No.2 March 2021

A case of intrathoracic administration of amphotericin B for empyema caused by Cunninghamella sp.

Yasuhiro Ue¹⁾, Atsuyoshi Okada¹⁾, Takeshi Nakamura¹⁾, Kazuya Ishii¹⁾, Nobutoshi Otsuka¹⁾, Yutaka Hirano²⁾ and Kazuhiro Washio²⁾

¹⁾Department of Hospital Pharmacy, Chugoku Central Hospital, 148-13 Miyuki Kamiiwanari, Fukuyama, Hiroshima, Japan
²⁾Department of Respiratory Surgery, Chugoku Central Hospital

Abstract

The patient was a 69-year-old man with lung cancer in the right lower lobe. Right S10 segmentectomy was performed by video-assisted thoracic surgery (VATS). He was followed up as an outpatient, but was later admitted as he developed persistent fever. Antibacterial drug therapy proved ineffective. Contrast-enhanced computed tomography (CT) loculated pleural effusion in the cavity around the resection, and drainage was performed. Pleural fluid culture revealed the presence of Cunninghamella sp., and the patient was started on treatment with 2.5 mg/kg/day of liposomal amphotericin B (L-AMB). However, the treatment proved ineffective at controlling the infection. The patient subsequently developed renal dysfunction and electrolyte imbalance, necessitating withdrawal of L-AMB. As this resulted in exacerbation of the infection, surgery was performed (lobectomy and fenestration), and treatment with L-AMB was initiated at a higher dose of 5 mg/kg/day. The pleural fluid test for Cunninghamella sp. subsequently turned negative. The infection came under control by 7 weeks after the dose of L-AMB was increased, and the lesion became localized to the thoracic cavity. Therefore, it was necessary to maintain a high concentration of AMB in the thoracic cavity, because the inflammation persisted. However, in view of the risk of side effects arising from the long-term administration of high-dose L-AMB, intravenous L-AMB was switched to intrathoracic administration of amphotericin B (AMPH-B). The new regimen was effective at suppressing the infection and the treatment was completed without recurrence of the infection.

Key word

Cunninghamella sp., mucormycosis, thoracic empyema, intrathoracic administration, amphotericin B

Received

August 11, 2020

Accepted

November 20, 2020

Jpn. J. Chemother. 69 (2): 131-136, 2021