Invasive aspergillosis sinonasal, orbital and cerebral treated with voriconazole: report of a case

R. Battikh, N. Ben Abdelhafidh, Mr Bacha, F. M'saddek, J. Laabidi, F. Laajili, B. Louzir, R. M'rissa, B. Jemli, K . Chatti, S. Gargouri, N. Ben Abdallah, S. Othmani


Invasive aspergillosis, brain particular, is a major cause of morbidity and mortality. Its occurrence on immunocompromised patients, frequent late diagnosis and vascular tropism of Aspergillus are the main factors aggravating the prognosis. However, it has been transformed by the imaging progress and molecular biology techniques and by the use of new antifungal agents.

In this regard, we report the case of a woman aged 53 years, type 2 diabetes, hospitalized in August 2004 in an array ?? intracranial hypertension associated with confuso-dreamlike and behavioral disorders lasting for one month. On examination, the patient was subfebrile 37.8 ° C and having a left oculomotor paresis associated with ?? inflammatory edema periorbital. The ENT examination was objectified inflammatory nasal mucosa with resulting pus at the meatus means left. Laboratory tests were unremarkable apart from unbalanced diabetes and discreet inflammatory syndrome. HIV serology was negative. Bi-frontal brain abscess, thrombophlebitis of the sagittal sinus, a pansinusitis and inflammatory periorbital left side have been objectified in ?? MRI. L ?? origin aspergillosis was retained on the isolation of the fungus on a fragment of a sinonasal biopsy positivity of aspergillus serology and negativity of bacteriological evaluation.

Amphotericin B anticoagulant and the clinical course was trailing with onset of kidney failure taking the replacement of Amphotericin B by voriconazole (VFEND *) at a dose of 400 mg / day, first intravenously for 2 weeks then orally for 4 months. ?? The evolution has been towards clinical improvement, biological and radiological. The decline is 8 months.

Conclusion: The arrival of new more powerful antifungal, having improved pharmacokinetics with fewer side effects will certainly upset not only the prognosis of these terrible infections, but also therapeutic attitudes.


Full conference title: 

Réunion Interdisciplinaire de Chimiothérapie Anti Infectieuse
    • RICAI 25th (2005)