Successful Multimodal Therapy with Intracerebral Liposomal Amphotericin B and Systemic High-Dose Isavuconazole in Proven Disseminated Aspergillosis.
| Autor: | Feys S; Medical Intensive Care Unit, UZ Leuven, 3000 Leuven, Belgium.; Department of Microbiology, Immunology and Transplantation, KU Leuven, 3000 Leuven, Belgium., Dedeurwaerdere F; Department of Pathology, AZ Delta, 8800 Roeselare, Belgium., Lagrou K; Department of Microbiology, Immunology and Transplantation, KU Leuven, 3000 Leuven, Belgium.; Department of Laboratory Medicine and National Reference Center of Mycoses, UZ Leuven, 3000 Leuven, Belgium., Van Lerbeirghe J; Department of Neurosurgery, AZ Delta, 8800 Roeselare, Belgium., Deeren D; Department of Hematology, AZ Delta, 8800 Roeselare, Belgium. |
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| Jazyk: | angličtina |
| Zdroj: | Journal of fungi (Basel, Switzerland) [J Fungi (Basel)] 2023 Mar 07; Vol. 9 (3). Date of Electronic Publication: 2023 Mar 07. |
| DOI: | 10.3390/jof9030327 |
| Abstrakt: | We report the case of a 32-year-old man receiving chemotherapeutics for an acute B-lymphoblastic leukemia who developed proven cerebral and pulmonary aspergillosis with Aspergillus flavus . Because of progressive fungal disease with neurological deterioration despite adequate systemic antifungal therapy and surgical debridement, intracerebral administration of liposomal amphotericin B was initiated at 5 mg twice weekly. This led to improvement of the cerebral infection. Surgical debridement of a pleural Aspergillus empyema was necessary, and pleural trough level of isavuconazole was found to be subtherapeutic despite adequate blood trough levels, which led us to increase the dose of isavuconazole. We conclude that intralesional amphotericin B might be beneficial at 5 mg twice weekly in cerebral aspergillosis if systemic antifungals and surgical debridement fail. In Aspergillus empyema, measurement of pleural isavuconazole trough levels should be considered. |
| Databáze: | MEDLINE |
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