Successful Treatment of Brain Abscesses Caused by Aspergillus nidulans



An 18 YO male underwent allogeneic matched peripheral blood stem cell transplantation for acute promyelocytic leukemia on 4/97 while in first remission.The post transplant period was uneventful until 2 m later, when he developed GVHD that was treated with cyclosporine and prednisone. Four months later bacteremia with Salmonella group B occurred. Brain CT disclosed a round enhancing lesion in the right temporo-parietal lobe a stereotactic biopsy of which revealed necrosis and septate hyphae, with a positive culture for Aspergillus nidulans. On 10/97 he underwent sub-total resection of the abscess and treatment with voriconazole was initiated. Two days later the patient developed severe abdominal pain with evidence of necrotizing pancreatitis. Antifungal treatment was switched to amphotericin B (AmB) 1.5mg/kg/d, and the pancreatitis recovered slowly. Due to impairment of renal function treatment was changed to AmB colloidal dispersion (Amphocil AE, (5mg/kg/d) for 2.5 m. Due to persistent renal failure, Amphocil AE was switched to liposomal AmB (AmBisome) at a dosage of 4 and then 1.6 mg/kg/d. Four m later progression of the occipital abscess was noted. The patient underwent a 2nd resection of the lesion. Pathological findings were unchanged but culture was negative. Thereafter the patient was treated with itraconazole 400mg/d but because of evidence of a new brain abscess he underwent a third craniotomy and resection of the abscess (7/98). ltraconazole was continued for 10 m at 800mg/d.At present, 15 m post transplantation no further abscesses have developed, and the patient is well except for left temporal hemianopsia. Aspergillus brain abscess is an uncommon disease. It is usually fatal, despite aggressive surgical resection and intensive antifungal therapy. Species belonging to the A. nidulans group were not considered as human pathogens until recently. Since they are as ubiquitous in nature as other species of Aspergillus, we hypothesize that they may be less pathogenic.

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5th Trends in Invasive and Fungal Infections
    • TIFI 5th