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Patients undergoing immunosuppressive therapy have a 21% risk of developing Pneumocystis carinii pneumonia (PCP) if no prophylaxis is used [1]. During the first 6 months after bone marrow transplantation (BMT), the recipients have an estimated 9% risk of developing PCP [2]. Standard prophylaxis with sulfamethoxazole and trimethoprim (SMX/TMP) daily or intermittent doses has been used effectively in transplant and other immunosuppressed patients [2–4]. However, poor compliance and undesirable myelotoxicity are expected with this schedule, especially if other myelotoxic drugs such as ganciclovir have to be administered. Aerosolized pentamidine (AP) has been considered an attractive alternative in AIDS patients who do not tolerate SMX/TMP because only 4% of the patients discontinue AP prophylaxis due to side effects [5].

SIR-Liposomal formulations of amphotericin B (AmB) have been shown to have fewer toxic effects than do classic preparations (such as AmB deoxycholate), yet they have equivalent antifungal activity [1, 2]. Recently, it has been reported that AmB liposomal emulsion (AmBLE [Intralipid 20%]) reduces renal and infusion-related toxicity. When AmBLE has been used to treat mild fungal infections, reduced toxicity and efficacy similar to that of conventional preparations have been observed [3]. However, no data are available concerning the effectiveness of AmBLE in treating severe fungal infections. We report three cases of fungal septicemia in profoundly granulocytopenic patients who were successfully treated with AmBLE. Case 1. A 9-year-old girl was admitted to the hospital for administration of a second cycle of salvage chemotherapy after a first relapse of non-Hodgkin's lymphoma. Seven days after chemotherapy was started, the patient had fever (temperature of 39?C) and hypotension, and her clinical condition had deteriorated. Findings on chest roentgenograms were normal. Progressive reduction in the total number of blood leukocytes was noted. Samples of blood for culture were taken before empirical antibiotic therapy with ceftazidime plus vancomycin was started.