Combined Ketoconazole and Amphotericin B Treatment of Acute Disseminated Histoplasmosis in a Renal Allograft Recipient

Abstract

We have reported the first case of successful treatment of disseminated histoplasmosis in a renal allograft recipient using a short course (14 days) of amphotericin B in combination with prolonged therapy (161 days) with ketoconazole. This regimen should decrease the risk of antibiotic induced nephrotoxicity, but it requires further study. Five days of treatment with ketoconazole alone was ineffective in our patient's infection. Our protocol might not be as efficacious in patients who are more profoundly immunocompromised, eg, bone marrow allograft recipients. Because relapse of histoplasmosis may occur as long as nine years after treatment, immunocompromised patients being treated with ketoconazole must have close long-term clinical follow-up.