A petite women in her 50’s with severe asthma and fungal sensitization (SAFS) had been unable to tolerate either itraconazole or voriconazole for any length of time, and was severely disabled with her symptoms. One treatment option which is occasionally helpful is to give nebulised amphotericin B (link to video of Helen). She was given 10mg of amphotericin B deoxycholate in water through a Pari LC nebulizer, supervised by a senior physiotherapist. Shortly after starting this, she felt much more breathless and the nebulizer was stopped. Salbutamol rescue was administered. After about 40 minutes she recovered.
The spirometer readings show a starting FEV1 of 2.35 L/sec. This fell to 1.05 L/sec, a dramatic fall with amphotericin B nebulisation. (Image A) She recovered with salbutamol to 2.25 L/sec. (Image B)
Patient diagnosed with Stage C Chronic Lymphocytic Leukaemia, treated in the MRC CLL4 study, with prednisolone for 4 weeks followed by oral chlorambucil for 7 days. Patient developed severe pneumonia due to pseudomonas and staphylococcus. Following treatment with broad spectrum antibiotics and 1 week of Abelcet, patient was readmitted with headache, disorientation and fever. CT brain scans showed 3 ring enhancing lesions, aspirated material showed neutrophils but grew aspergillus. Patient now improved on Abelcet (4 mg/kg) and oral itrconazole suspension 200mg b.d.
Thanks to Richard Chasty, Consultant Haematologist, North Staffordsire Hospital, UK.
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![Asp[1]niger](https://www.aspergillus.org.uk/wp-content/uploads/2013/11/Asp1niger-150x150.gif "Asp[1]niger")
