1. Successful treatment with voriconazole of Aspergillus brain abscess in a boy with medulloblastoma.
- Author
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Stiefel M, Reiss T, Staege MS, Rengelshausen J, Burhenne J, Wawer A, and Foell JL
- Subjects
- Administration, Oral, Antifungal Agents administration & dosage, Antifungal Agents cerebrospinal fluid, Antifungal Agents pharmacology, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Brain Abscess diagnosis, Brain Abscess etiology, Brain Abscess microbiology, Carboplatin administration & dosage, Cerebral Ventricle Neoplasms drug therapy, Cerebral Ventricle Neoplasms radiotherapy, Cerebral Ventricle Neoplasms surgery, Child, Combined Modality Therapy, Cranial Irradiation, Craniotomy, Cyclophosphamide administration & dosage, Diagnostic Errors, Etoposide administration & dosage, Humans, Immunocompromised Host, Infusions, Intravenous, Lomustine administration & dosage, Male, Medulloblastoma drug therapy, Medulloblastoma radiotherapy, Medulloblastoma surgery, Methotrexate administration & dosage, Neoplasm Recurrence, Local diagnosis, Neuroaspergillosis complications, Neuroaspergillosis diagnosis, Pyrimidines administration & dosage, Pyrimidines cerebrospinal fluid, Pyrimidines pharmacology, Surgical Wound Infection etiology, Triazoles administration & dosage, Triazoles cerebrospinal fluid, Triazoles pharmacology, Vincristine administration & dosage, Voriconazole, Antifungal Agents therapeutic use, Aspergillus fumigatus drug effects, Brain Abscess drug therapy, Cerebral Ventricle Neoplasms complications, Medulloblastoma complications, Neuroaspergillosis drug therapy, Pyrimidines therapeutic use, Surgical Wound Infection drug therapy, Triazoles therapeutic use
- Abstract
Invasive aspergillosis is an increasing problem in immuno-incompetent patients after prolonged steroid therapy, cancer radio-chemotherapy, and bone marrow or solid organ transplantation. Cerebral aspergillosis is a well-described complication of the invasive aspergillosis but only in rare cases, the brain is the sole site of infection. Despite increasing availability of antifungal drugs, the prognosis of cerebral aspergillosis is poor. We report on an 11-year-old boy with medulloblastoma in the area of the fourth ventricle. Following tumor surgery and radio-chemotherapy, several abscess-like structures occurred in the operating field. After incomplete abscess, resection histology and culture confirmed a localized Aspergillus fumigatus infection. The initial treatment of the Aspergillus fumigatus infection with conventional amphotericin B failed, and treatment with the triazole voriconazole was started. Intravenous treatment with voriconazole resulted in a reduction of the Aspergillus fumigatus abscess. After switching to oral ambulatory therapy, the Aspergillus fumigatus abscess increased in size. To improve treatment, voriconazole dosage was adapted to reach drug concentrations in cerebrospinal fluid (CSF) above the minimal fungicidal concentration and plasma specimens. During the concentration-controlled voriconazole therapy for a period of 18 months, a complete response was achieved.
- Published
- 2007
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