Liposomal amphotericin and caspofungin: Salvage therapy for invasive aspergillosis in hepatic failure

Abstract

Background: Invasive aspergillosis is a life-threatening condition associated with severe morbidity and mortality. There are limited data on the treatment of invasive aspergillosis in solid organ transplant recipients. Aim: To describe a case of invasive pulmonary aspergillosis in a patient with hepatic failure secondary to paracetamol overdose who subsequently underwent liver transplantation. Clinical Details: A 33-year-old female was admitted with fulminant hepatic failure secondary to paracetamol overdose who subsequently underwent liver transplantation. She developed invasive pulmonary aspergillosis prior to transplantation. Her infection progressed despite initial treatment with liposomal amphotericin. Caspofungin was added to her therapy and she improved. Her antifungal was later changed to oral voriconazole. Outcomes: Invasive pulmonary aspergillosis responded to the combination therapy of liposomal amphotericin and caspofungin. Conclusion: Antifungal therapy of invasive aspergillosis in solid organ transplant recipients is complex and challenging. Treatment with liposomal amphotericin and caspofungin may be considered as salvage therapy for liver transplant recipients with invasive Aspergillus fumigatus and renal failure.