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Re: Angio-invasive aspergillosis - treatment optio

David Denning
May 04, 1999 10:37PM
Dear Dr Demey,
This is a difficult problem and unfortunately you may lose him whatever you do.
Given that you cannot use a lipid-based ampho (and assuming that intralipid ampho is as good as the real stuff which is far from certain (it was worse against crypto meningiitis in one randomised study)), I would go to either MK-0991 or voriconazole. The response rate with voriconazole will be about 30% in this setting and no one knows how good MK-0991 is yet in any setting. I would make the change as fast as you can. Contact details are given on this site under research, clinical studies.
> I am treating a 71 years old male under chronic treatment with azathiorpine and prednisolone for rheumatoid arthritis, who was diagnosed with angio-invasive aspergillosis + cytomegalovirus pneumonia + rheumatoid lung + BOOP + pulmonar embolism + emphysematous leasions in both upper lung lobes (yes, I know, an impressive list!)
> He is intubated and fully ventilated with about 50% oxygen. He has been treated with ampho B 100 mg/day in Intralipid 20%, now for 15 days, + gancyclovir + prednisolone (BOOP and rheumatoid lung). However, his condition is deteriorating with extension of the pulmonary infiltrates and deterioration of oxygenation parameters.
> I would like to have Your expert opinion on alternative treatment options: growth factors? association of ampho with itraconazole or voriconazole? lung resection (complete pneumonectomy)? For Your information, the lipid-based ampho B complexes are not available in Belgium on compassionate use base and too expensive.
Subject Author Posted

Angio-invasive aspergillosis - treatment options?

Hendrik E Demey, MD May 04, 1999 10:04AM

Re: Angio-invasive aspergillosis - treatment optio

David Denning May 04, 1999 10:37PM



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