engleski

Amphotericin B and mefloquine as a salvage treatment of alveolar echinococcosis - a case report

Alveolar echinococcosis (AE) is a zoonotic infection caused by the parasite Echinococcus multilocularis. While surgery remains the only curative treatment strategy, most patients are diagnosed at a late stage when the disease has advanced to unresectable hepatic lesions. Thus, lifelong treatment with albendazole or mebendazole is needed for prevention of disease progression. Here we present a 67-year-old male patients that was diagnosed with unresectable alveolar echinococcosis in 2017. The patient had liver lesion (13 × 12 × 12 cm) with infiltration of lungs and right adrenal gland. Initially he was treated with albendazole, and in 2018 due to disease progression, right hepatic lobe and right- sided diaphragm resection was performed, along with right adrenalectomy and hepaticojejunostomy. Due to surgical procedure complications, a part of the cyst remained in place. After surgery, albendazole treatment was continued. From the beginning of 2019, the patient experienced several episodes of anaemia, thrombocytopenia and severe neutropenia. Albendazole was shortly discontinued, then reintroduced with dose adjustments, however with further recurrences of leukopenia. Hence, a rescue treatment with amphotericin B deoxycholate (AmpB) was started from mid-2019. After induction therapy (50mg/day for 14 days), the AmpB was administered once per week for two years, which resulted in suppressive effect on the disease progression. In 2021, there were no active lesions on PET-CT scan. However, due to a rise in serum creatinine and gamma-glutamyl transferase, amphotericin B was discontinued in mid-2021, and mefloquine once per week was initiated. The patient is tolerating the medication well, and to this day there are no clinical signs of disease progression. This case demonstrates a possible salvage treatment of AE with AmpB and mefloquine for patients who are not able to tolerate benzmidazoles

Alveolar echinococcosis ; hepatic lesion ; amphotericin

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