Local arterial infusion of amphotericin B for refractory aspergillosis

A 41-year-old man with HIV infection and cytomegalovirus retinitis complained of fever and intractable headache. MRI and CT scans revealed a mass lesion in the left sphenoidal sinus with invasion around the cavernous sinus. A culture of biopsy material from the lesion yielded Aspergillus, and histologic examination found evidence of tissue invasion of the sinus mucosa. Amphotericin B was given, without response. Amphotericin B lipid complex was substituted because of worsened renal function. Nine months later, the patient underwent cannulation and arteriography of the left maxillary artery and amphotericin B was infused, with resolution of symptoms. The patient survived for 8 months with improved quality of life.