{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,17]],"date-time":"2025-09-17T05:47:09Z","timestamp":1758088029599,"version":"3.44.0"},"reference-count":12,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,9,16]],"date-time":"2025-09-16T00:00:00Z","timestamp":1757980800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:p>Pulmonary mucormycosis caused by <jats:italic>Rhizopus arrhizus<\/jats:italic> is an emergent, fulminant threat in immunocompromised hosts, yet therapeutic success remains elusive when extracorporeal membrane oxygenation (ECMO) is required. While liposomal amphotericin B (L-AMB) is endorsed as first-line therapy, its pharmacokinetics are profoundly altered by ECMO\u2014dilution, circuit sequestration, and impaired lung penetration all conspire to sub-therapeutic exposure. We report the first documented case in which these challenges were systematically overcome. A 52-year-old cardiac-transplant recipient, supported on veno-venous ECMO for refractory hypoxaemia, developed rapidly progressive pneumonia. Metagenomic next-generation sequencing (mNGS) of bronchoalveolar lavage fluid returned a definitive <jats:italic>Rhizopus arrhizus<\/jats:italic> signature within 24\u202fh, prompting immediate escalation to high-dose L-AMB (10\u202fmg\/kg\/day). Therapeutic drug monitoring confirmed sustained trough levels above 7\u202f\u03bcg\/mL despite a 3.5-fold increase in volume of distribution. Serial mNGS quantification demonstrated a logarithmic decline in fungal reads to undetectable levels by day 10, accompanied by radiological resolution and preserved renal function. After 28\u202fdays of intravenous therapy, the patient was discharged on oral isavuconazole with no relapse at 6\u202fmonths. This case establishes that early pathogen identification by mNGS, coupled with aggressive L-AMB dose optimisation under rigorous pharmacokinetic guidance, can achieve cure of pulmonary mucormycosis even in the most pharmacologically hostile environment of ECMO support.<\/jats:p>","DOI":"10.3389\/fmed.2025.1631873","type":"journal-article","created":{"date-parts":[[2025,9,16]],"date-time":"2025-09-16T04:14:04Z","timestamp":1757996044000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Pulmonary Rhizopus arrhizus infection treated with high-dose liposomal amphotericin B in a heart transplant recipient under ECMO: a case report"],"prefix":"10.3389","volume":"12","author":[{"given":"Wei","family":"Jiang","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jinghui","family":"Zhai","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Boyu","family":"Li","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jie","family":"Ma","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sixi","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2025,9,16]]},"reference":[{"key":"ref1","first-page":"597","article-title":"Chinese expert consensus on clinical diagnosis and treatment of mucormycosis","volume":"62","year":"2023","journal-title":"J Chin Intern Med"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"101474","DOI":"10.1016\/j.rmcr.2021.101474","article-title":"Challenges in the diagnosis of pulmonary mucormycosis in a diabetic with a review of literature","volume":"33","author":"Yousaf","year":"2021","journal-title":"Respir Med Case Rep"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"11108","DOI":"10.12998\/wjcc.v9.i35.11108","article-title":"Rhizopus microspores lung infection in an immunocompetent patient successfully treated with amphotericin B: a case report","volume":"9","author":"Chen","year":"2021","journal-title":"World J Clin Cases"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"e405","DOI":"10.1016\/S1473-3099(19)30312-3","article-title":"Global guideline for the diagnosis and management of mucormycosis: an initiative of the European Confederation of Medical Mycology in cooperation with the mycoses study group education and research consortium","volume":"19","author":"Cornely","year":"2019","journal-title":"Lancet Infect Dis"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"38","DOI":"10.3760\/cma.j.issn.1001-0939.2018.06.004","article-title":"Expert consensus on the clinical application of pharmacokinetics\/pharmacodynamics theory of antimicrobial agents","volume":"41","year":"2018","journal-title":"J Chin Tuberc Respir Dis"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"1976","DOI":"10.1016\/j.clinthera.2016.07.169","article-title":"Pharmacokinetics and dosing of anti-infective drugs in patients on extracorporeal membrane oxygenation: a review of the current literature","volume":"38","author":"Sherwin","year":"2016","journal-title":"Clin Ther"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"661","DOI":"10.1111\/jcpt.12636","article-title":"Pharmacokinetic changes of antibiotic, antiviral, antituberculosis and antifungal agents during extracorporeal membrane oxygenation in critically ill adult patients","volume":"42","author":"Hahn","year":"2017","journal-title":"J Clin Pharm Ther"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"737","DOI":"10.1007\/s15010-017-1042-z","article-title":"Pharmacokinetics of antifungal drugs: practical implications for optimized treatment of patients","volume":"45","author":"Bellmann","year":"2017","journal-title":"Infection"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"e229612","DOI":"10.1136\/bcr-2019-229612","article-title":"Treatment of pulmonary blastomycosis with high-dose liposomal amphotericin B in a patient receiving extracorporeal membrane oxygenation","volume":"12","author":"Servais","year":"2019","journal-title":"BMJ Case Rep"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"89","DOI":"10.1002\/phar.2348","article-title":"Altered pharmacokinetics and dosing of liposomal amphotericin B and isavuconazole during extracorporeal membrane oxygenation","volume":"40","author":"Zhao","year":"2020","journal-title":"Pharmacotherapy"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"3487","DOI":"10.1128\/AAC.45.12.3487-3496.2001","article-title":"Safety, tolerance, and pharmacokinetics of high-dose liposomal amphotericin B (AmBisome) in patients infected with aspergillus species and other filamentous Fungi: maximum tolerated dose study","volume":"45","author":"Walsh","year":"2001","journal-title":"Antimicrob Agents Chemother"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"ofae270","DOI":"10.1093\/ofid\/ofae270","article-title":"Antifungals in patients with extracorporeal membrane oxygenation: clinical implications","volume":"11","author":"K","year":"2024","journal-title":"Open Forum Infect Dis"}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2025.1631873\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,16]],"date-time":"2025-09-16T04:14:06Z","timestamp":1757996046000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2025.1631873\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,16]]},"references-count":12,"alternative-id":["10.3389\/fmed.2025.1631873"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2025.1631873","relation":{},"ISSN":["2296-858X"],"issn-type":[{"type":"electronic","value":"2296-858X"}],"subject":[],"published":{"date-parts":[[2025,9,16]]},"article-number":"1631873"}}