Pulmonary and ocular aspergillosis with reduced susceptibility to amphotericin B: A Malaysian case series

Background

Elevated amphotericin B (AmB) minimum inhibitory concentrations (MICs) in Aspergillus spp. may compromise empirical therapy. We describe three aspergillosis cases caused by distinct species with AmB MICs >16 µg/mL. Case presentations: The first case involved postoperative invasive pulmonary aspergillosis due to A. fumigatus. Conventional AmB was used initially because renal impairment and bowel ischaemia limited voriconazole use; the patient later died with multiorgan failure, invasive aspergillosis and nosocomial infections. The second case involved traumatic A. flavus keratitis with newly diagnosed diabetes mellitus. The ocular infection resolved after voriconazole-based therapy and therapeutic keratoplasty, but graft failure and severe visual impairment persisted. The third case involved an infected corneal hydrops with exogenous endophthalmitis due to A. versicolor complex. Despite keratoplasty, vitrectomy and voriconazole-based therapy, the eye progressed to phthisis bulbi.