Cure of chronic invasive sinus aspergillosis with oral saperconazole

We report a case of chronic invasive aspergillosis of the maxillary sinus which continued to progress despite treatment with high doses of oral itraconzole. The patient was unable to tolerate treatment with intravenous amphotericin B and had limited response to two different lipid-complexed preparations of amphotericin B (AmBisome, Vestar Ltd; Amphocil, Liposome Technology Inc.). Treatment with oral saperconazole (Cilag Ltd) resulted in a dramatic clinical and radiological response but was associated with abnormalities of liver function at a daily dose of 200 mg 12 hourly. These biochemical abnormalities were not associated with clinical symptoms and resolved fully within 2 weeks of reducing the dose to 100 mg 12 hourly. Saperconazole may represent an effective treatment of invasive sinus aspergillosis in patients who are unable to tolerate, or fail treatment with itraconazole and amphotericin B.