Case presentation
An 81-year-old female patient presented to our institution with gross
hematuria, fatigue, nausea, anorexia, and progressively deteriorating
renal function. ANCA enzyme immunoassay revealed a perinuclear staining
pattern (p-ANCA) and serum anti-myeloperoxidase (MPO) antibody titer of
119 units/ml. She initially improved with intravenous
methylprednisolone. However, after tapering the glucocorticoids and
starting cyclophosphamide, her appetite and general state worsened, with
increased body temperature, but serum creatinine and C-reactive protein
concentrations and the erythrocyte sedimentation rate keep being
decreased. Intravenous immunoglobulin and antibiotics had no effect.
Intensive immunosuppressive therapy was initiated, and just as she
improved, she suddenly developed purulent and blood-tinged sputum.
Computed tomography of the chest showed a solid nodule with cavitation
in the dorsal segment of the left lower lobe. Sputum culture revealed
growth of Mucor species. Amphotericin B liposomes (LAMB) were
administrated, and the cumulative dosage was 2.0 g with 2 months’
treatment duration. Finally, repeat sputum culture was negative, the
nodular lesion disappeared, and only a cystic air space remained. No
nephrotoxicity with LAMB was seen.