[Hepatic arterial infusion of liposomal amphotericin B for multiple fungal abscesses in the liver of a patient with chronic granulomatous disease].

A 26-year-old man with chronic granulomatous disease complicated by multiple liver abscess was admitted to our hospital for hepatic resection and allogeneic bone marrow transplantation (BMT) from an HLA-matched sibling. We diagnosed the patient with Aspergillus liver abscesses based on computed tomographic findings, elevated serum levels of beta-D-glucan, positive test for galactomannan antigen, and the findings of laboratory cultures. Since the liver abscess could not be treated by drainage and administration of antifungals, we resected the posterior segments of the liver, which contained the abscess (S1, S6). However, abscess recurred in the remaining part of the liver 1 month later. The patient received allogeneic BMT from an HLA-matched sibling. During BMT, we continuously administered liposomal amphotericin B (L-AMB) via the hepatic artery (25 mg/day) to treat the liver abscess. There were no adverse effects during hepatic arterial infusion of L-AMB, and the liver abscess disappeared after BMT. These results suggest that hepatic arterial infusion of L-AMB is effective in treating fungal abscess in the liver.

A long-term survivor of leiomyosarcoma around the right side of the base of the skull: effective radiotherapy combined with intra-arterial chemotherapy.

We report a rare case of a leiomyosarcoma that developed around the right side of the base of the skull in a 51-year-old woman. The patient consulted our hospital complaining of pain in the right side of her neck and upper right arm in August 1994. A leiomyosarcoma, originating around the right side of the neck and base of the skull was diagnosed. Initially, surgery was planned, but invasion into the spinal canal was discovered. Curative resection of the leiomyosarcoma around the right side of the base of the skull was not possible. Therefore, external beam radiotherapy (EBRT) combined with intra-arterial chemotherapy and hyperthermia was employed. After the treatment, the tumor decreased in size to 45% of its initial volume, and, simultaneously, her symptoms completely disappeared. The patient initially remained clinically free of the disease, but showed reaggravations at the primary tumor site 3 years and 3 months, and 4 years and 11 months, after the first treatment. The reaggravations were treated with EBRT combined with intra-arterial chemotherapy. As a result, she survived for 5 years and 7 months after the first treatment.