Use of posaconazole in the treatment of infective rhinocerebral mucormycosis

Abstract

Introduction: A patients with undiagnosed type II diabetes mellitus presented with infective rhinocerebral mucormycosis.Investigation results: Initial magnetic resonance imaging scans demonstrated an aggressive disease process involving the left orbit and paranasal sinuses. A repeated scan following treatment excluded intracranial spread or recurrence. Pus from the paranasal sinuses grew Rhizopus arrhizus on microbiological culture.Management: Initial treatment comprised intravenous liposomal amphotericin B, intravenous co-amoxiclav and surgical debridement. The patient's diabetes was managed medically. The development of drug-induced transaminitis required a change of medication. The dose of liposomal amphotericin B was reduced, and then titrated back up as the liver function test results improved. Posaconazole was also introduced and the patient was eventually discharged on this alone, as the maximum recommended cumulative dose of liposomal amphotericin B had been reached.Conclusions: Posaconazole may be used effectively in conjunction with surgical debridement in the treatment of patients with infective rhinocerebral mucormycosis who develop hepatotoxic side effects to liposomal amphotericin B. Posaconazole may also allow a reduction in the dose of liposomal amphotericin B, resulting in better tolerance.

Rhinocerebral mucormycosis—a case report

“…Mallis et al proposed that antifungal drugs of the azole group and new iron chelating agents-deferasirox and deferiprone-have been supported as alternative options to amphotericin B or as salvage therapy [9]. Kulendra et al proposed that posaconazole may be used effectively in conjunction with surgical debridement in the treatment of patients with infective rhinocerebral mucormycosis who develop hepatotoxic side effects to liposomal amphotericin B. Posaconazole may also allow a reduction in the dose of liposomal amphotericin B, resulting in better tolerance [10]. We did not use any of the newer antifungal drug or liposomal amphotericin preparation because of its considerable costing as discussed by Handzel [11].…”

Dental and Oral Manifestations of COVID-19 Related Mucormycosis: Diagnoses, Management Strategies and Outcomes

“…It is also recommended as drug of choice for prophylaxis against COVID associated mucormycosis in susceptible individuals [118,159]. Posaconazole has also been used in conjunction with amphotericin B and this combination allows reduction in the overall dose of both drugs leading to better tolerability and efficacy [160]. The use of posaconazole in ROCM cases has been shown to prevent the need for orbital exenteration [161].…”

Treatment of Invasive Mucormycosis with Intravenous Isavuconazonium and Topical Amphotericin B in a Renal-Impaired Patient: Case Report and Review of the Literature

“…Recent reports have suggested posaconazole (a secondgeneration azole anti-fungal agent) as a viable alternative to amphotericin B-intolerant non-burn patients with invasive mucormycosis [18,19]. Isavuconazonium sulfate (Cresemba) has also been reported to be effective in the treatment of nonburn wound mucormycosis refractory to amphotericin B and posaconazole [3].…”