Is posaconazole a new treatment option for brain abscess?

L. Matkham, C. Garzoni, B. Hirschel, S. Harbarth, K. Bouchuigui-Waf, J. Garbino

Author address: 

Geneva, CH

Abstract: 

Introduction: Cladophialophora bantiana is a dematiaceous fungus, a rare cause of cerebral abscess. Its high mortality is related to its poor response to currently available anti-fungal therapy. Case report: A 60-year old Egyptian woman with a systemic sclerosis and long term corticoid therapy, pulmonary fibrosis chronic hepatitis C with cirrhosis, chronic thrombocytopenia and arterial hypertension. The patient was hospitalised for frequent falls and confusion. On admission, the patient was febrile, sleepy and confused. A CT-scan showed an expansive lesion compressing the left lateral ventricle. The magnetic resonance image (MRI) suggested an image of glioblastoma and a chemotherapy was started. The patient developed a progressive right hemiparesis, aphasia and worsened in sensorium. Cerebral biopsy was performed on hospital day 12. Due to its location resection was not possible and aspiration was done. The microbiological cultures yielded a Cladophialophora bantiana. A treatment was initiated with voriconazole 400 mg po/12 h and liposomal amphotericin B 7 mg/kg/d. The MRI 5 days after showed increased size lesion. Increased in liver tests suspected hepatic toxicity and voriconazole was replaced by posaconazole 400 mg/12 h. A MRI done after 16 days of posaconazole treatment showed a similar size of the lesion, but without peri-lesional oedema. In addition to her neurological problems the patient developed pneumonia with severe sepsis and continued to deteriorate and died. Discussion: Phaeohypomycosis is the infection caused by dematiaceaous moulds which are unique owing to presence of melanin pigments in their cell walls and spores. Melanin may be a virulence factor in these fungi. Dematiaceous fungi are widespread in the environment especially in the soil and decaying vegetation One of them C. bantiana has a predilection for brain tissue. Recommendation for therapy is based upon the experience of published cases. Long-term survival is reported only when complete surgical resection of the lesion is possible accompanied by an anti-fungal treatment. The recommended treatment is high dose of amphotericin B in combination with a new triazole and if is it possible 5 fluctocystosine. Posoconazole could be a new drug option for its better tolerability and less drug-drug interactions.
2006

abstract No: 

P1212

Full conference title: 

16th European Congress of Clinical Microbiology and Infectious Diseases
    • ECCMID 16th (2006)