Abstract | November 8, 2021

Radical Treatment for Blastomycosis Following Failed Liposomal Amphotericin

Presenting Author: Christopher Chew, BS, MPH, MD, Internal Medicine Resident PGY2, Graduate Medical Education - Internal Medicine, Northeast Georgia Medical Center, Gainesville, Georgia, Gainesville, GA

Coauthors: Nikhilesh Thapa, DO, Internal Medicine, PGY2, Northeast Georgia Medical Center, Gainesville, GA; Henry Ogbuagu, MD, Internal Medicine, PGY2, Northeast Georgia Medical Center, Gainesville, GA; Merin Varghese, MD, Infectious Disease, Northeast Georgia Medical Center, Gainesville, GA ; Dhaval Patel, MD, Critical Care, Northeast Georgia Medical Center, Gainesville, GA; Raza Abbas, MD, Interventional Cardiology, Northeast Georgia Medical Center, Gainesville, GA; Jason Oh, MD, Critical Care, Northeast Georgia Medical Center, Gainesville, GA; Barry Barns, PharmD, Pharmacy, Northeast Georgia Medical Center, Gainesville, GA

Learning Objectives

  1. This case demonstrates the importance of considering AmB-d continuous infusions in patients with severe blastomycosis who may have poor response to L-AmB in addition to the use of EMCO therapy. 

Introduction: Pulmonary blastomycosis is a respiratory disease that is caused by the fungus Blastomyces, most commonly through inhalation of the fungal spores. Infected individuals typically show symptoms 3 weeks to 3 months after inhalation of these spores. About 50% of the patients with pulmonary blastomycosis are asymptomatic. Individuals with severe blastomycosis are initially treated with intravenous antifungal therapy. Amphotericin B is the drug of choice for moderate to severe blastomycosis with long-term itraconazole maintenance therapy. 

Case Presentation: We present the case of an immunocompetent young male who was diagnosed with chronic pulmonary Blastomyces dermatitidis and had poor clinical response to 10 days of liposomal Amphotericin B (L-AMB). Due to persistent hypoxia and hypoxemia patient was endotracheally intubated and extracorporeal membrane oxygenation (ECMO) was initiated. We decided to discontinue L-AmB, initiate continuous infusion of amphotericin B deoxycholate (AmB-d), and start a short course of corticosteroids which led to significant clinical improvement. He was taken off ECMO on day 9 and extubated on day 12 of AmB-d continuous infusion. 

Final Outcome and Follow-up: Following decannulation from ECMO and extubation patient ultimately was transitioned from continuous infusion of amphotericin B deoxycholic to itraconazole. Patient has since been maintained on itraconazole as an outpatient and has had significant improvement in his imaging findings since discharge. Remained stable on room air. 

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