{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T23:48:25Z","timestamp":1777420105139,"version":"3.51.4"},"reference-count":14,"publisher":"SAGE Publications","issue":"6","license":[{"start":{"date-parts":[[2013,5,14]],"date-time":"2013-05-14T00:00:00Z","timestamp":1368489600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Ann Pharmacother"],"published-print":{"date-parts":[[2013,6]]},"abstract":"\n OBJECTIVE:<\/jats:title>\n To describe a case of successful treatment of severe pulmonary blasto mycosis with amphotericin B deoxycholate after failure of liposomal amphotericin B.<\/jats:p>\n <\/jats:sec>\n \n CASE SUMMARY:<\/jats:title>\n A 35-year-old male was exposed to damp decomposing wood while cleaning his basement. He subsequently developed a cough, malaise, fever, nausea, vomiting, and diarrhea. He was admitted to the hospital and intubated for worsening pulmonary symptoms. Microscopic examination of his sputum indicated Blastomyces dermatitidis. Liposomal amphotericin B was administered for 6 days, but the patient's temperature reached 39.6 \u00b0C and his white blood cell (WBC) count reached 52,300\/ \u03bcL. Extensive consolidation of both lungs fields was observed on chest X-ray. Because of progressive clinical deterioration, the treatment was switched to amphotericin B deoxycholate by continuous infusion. That change resulted in clinical improvement, with abrupt reductions (within 48 hours) in temperature and the WBC count. By day 14 of therapy (day 8 of amphotericin B deoxycholate), the chest X-ray showed improvement in diffuse airspace filling. After 16 days of amphotericin B treatment, intravenous followed by oral voriconazole was administered for 3 months. Eight months later the patient's strength had improved significantly, but he still had occasional episodes of shortness of breath.<\/jats:p>\n <\/jats:sec>\n \n DISCUSSION:<\/jats:title>\n The management of blastomycosis is challenging because of the lack of clinically supporting data. The gold standard for severe pulmonary blastomycosis had been amphotericin B deoxycholate; however, improved safety data with liposomal amphotericin B for other fungal infections has suggested this as an effective alternative. This report describes a patient with severe pulmonary blastomycosis failing 6 days of liposomal amphotericin B, yet he tolerated and clinically responded to continuous infusion of amphotericin B deoxycholate. Based on this case report and a simulated pharmacokinetic\/pharmacodynamic analysis, continuous infusion of amphotericin B deoxycholate may be a reasonable option for enhanced efficacy and minimal toxicity in patients with blastomycosis.<\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS:<\/jats:title>\n Ours is the first case report to use continuous infusion of amphotericin B deoxycholate for the management of pulmonary blastomycosis. These results suggest that liposomal amphotericin B may not be adequate in some patients for the management of B. dermatitidis pulmonary infections.<\/jats:p>\n <\/jats:sec>","DOI":"10.1345\/aph.1r703","type":"journal-article","created":{"date-parts":[[2013,5,15]],"date-time":"2013-05-15T00:33:24Z","timestamp":1368578004000},"page":"e26-e26","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":6,"title":["Successful Treatment of Pulmonary Blastomycosis with Continuously Infused Amphotericin B Deoxycholate After Failure with Liposomal Amphotericin B"],"prefix":"10.1177","volume":"47","author":[{"given":"Robert E","family":"Ariano","sequence":"first","affiliation":[{"name":"Robert E Ariano PharmD BCPS FCCM, Critical Care Pharmacist, Department of Pharmacy, St. Boniface General Hospital; Clinical Associate Professor, Faculty of Pharmacy, Department of Pharmacology and Therapeutics, Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bradley R","family":"Mitchelmore","sequence":"additional","affiliation":[{"name":"Bradley R Mitchelmore PharmD ACPR, Clinical Assistant Professor, Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, Alberta, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Philippe RS","family":"Lagac\u00e9-Wiens","sequence":"additional","affiliation":[{"name":"Philippe RS Lagac\u00e9-Wiens MD DTM&H FRCPC, Department of Medical Microbiology and Infectious Diseases, Faculty of Medicine, University of Manitoba; Department of Clinical Microbiology, Diagnostic Services of Manitoba"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sheryl A","family":"Zelenitsky","sequence":"additional","affiliation":[{"name":"Sheryl A Zelenitsky PharmD, Professor, Faculty of Pharmacy, University of Manitoba; Department of Pharmacy, St. Boniface General Hospital; Department of Medical Microbiology and Infectious Diseases, Faculty of Medicine, University of Manitoba"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2013,5,14]]},"reference":[{"key":"bibr1-aph.1R703","doi-asserted-by":"publisher","DOI":"10.1086\/588300"},{"key":"bibr2-aph.1R703","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.35.10.2144"},{"key":"bibr3-aph.1R703","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/32.3.465"},{"key":"bibr4-aph.1R703","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.50.2.674-684.2006"},{"key":"bibr5-aph.1R703","doi-asserted-by":"publisher","DOI":"10.1086\/313828"},{"key":"bibr6-aph.1R703","doi-asserted-by":"publisher","DOI":"10.1681\/ASN.V62154"},{"key":"bibr7-aph.1R703","doi-asserted-by":"publisher","DOI":"10.1086\/514193"},{"key":"bibr8-aph.1R703","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.46.3.834-840.2002"},{"key":"bibr9-aph.1R703","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.322.7286.579"},{"key":"bibr10-aph.1R703","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199903113401004"},{"key":"bibr11-aph.1R703","doi-asserted-by":"publisher","DOI":"10.1111\/j.1469-0691.2009.02913.x"},{"key":"bibr12-aph.1R703","doi-asserted-by":"publisher","DOI":"10.1055\/s-0031-1295726"},{"key":"bibr13-aph.1R703","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.46.3.828-833.2002"},{"key":"bibr14-aph.1R703","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.1988.00380110049010"}],"container-title":["Annals of Pharmacotherapy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1345\/aph.1R703","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1345\/aph.1R703","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1345\/aph.1R703","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T11:12:54Z","timestamp":1777374774000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1345\/aph.1R703"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2013,5,14]]},"references-count":14,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2013,6]]}},"alternative-id":["10.1345\/aph.1R703"],"URL":"https:\/\/doi.org\/10.1345\/aph.1r703","relation":{},"ISSN":["1060-0280","1542-6270"],"issn-type":[{"value":"1060-0280","type":"print"},{"value":"1542-6270","type":"electronic"}],"subject":[],"published":{"date-parts":[[2013,5,14]]}}}