[Amphotericin B and flucytosine therapy of Aspergillus pneumonia and acute renal failure]

Abstract

Kidney failure and pneumonia by Aspergillus flavus and A. fumigatus were found in a 56-year-old woman who had received antibiotic and corticoid treatment to control high fever. Her bloody tracheal secretion was a suspension of granule-like spore-free colonies of both Aspergillus species. Hemorrhages in mucous membranes and skin suggested a hematogenous dissemination of the fungi. Aspergillus spores in the soil of ornamental plants were assumed to be responsible for the inhalatory infection. The kidney function normalized rapidly under treatment by amphotericin B plus flucytosine and hemodialysis performed eight times. After 29 days of antimycotic treatment (amphotericin B 463 mg, flucytosine 150 g), besides normalization of the kidney function, healing of the pneumonia and bleeding from skin and mucal membranes took place. One and a half years later kidney function and blood parameters were found to be normal. In cases of Aspergillus pneumonia and kidney failure, a combined treatment by hemodialysis and amphotericin B plus flucytosine is recommended. In addition, there is discussion of the general importance of uremia and its influence on the mycotic infection.