title: Breakthrough Scedosporium apiospermum (Pseudallescheria boydii) brain abscess during therapy for invasive pulmonary aspergillosis following high-risk allogeneic hematopoietic stem cell transplantation. Scedosporiasis and recent advances in antifungal therapy.
abstract: Systemic scedosporiasis due to the anamorph or asexual form Scedosporium apiospermum (Pseudallescheria boydii) has become an important cause of opportunistic mycosis, especially in patients undergoing high-risk hematopoietic stem cell transplantation. We report a case of rapidly progressive cerebellar hyalohyphomycosis due to Scedosporium apiospermum in an allogeneic marrow graft recipient receiving treatment for severe graft-versus-host disease. This fatal breakthrough intracranial abscess, due to amphotericin B-resistant (minimum inhibitory concentration > 16 micro g/ml) mold, developed during the course of systemic antifungal therapy given for multicentric pulmonary aspergillosis. Despite treatment with high-dose Abelcet (10 mg/kg daily), free amphotericin B was not detected in postmortem cerebellar tissue. A broad-spectrum triazole-based agent (voriconazole/UK-109, 496--Vfend), and a novel fungal cell wall inhibitor, an echinocandin/pneumocandin analog (caspofungin/MK-0991--Cancidas), which exhibit excellent in vitro activity against most clinical Pseudallescheria boydii-Scedosporium apiospermum isolates, have recently become available in the United States and may provide much needed treatment options for patients at risk.
authors.affiliation: Infectious Diseases, Memorial Sloan-Kettering Cancer Center, New York, NY, USA. asafdar@mdanderson.org
authors.forename: A
authors.initials: A
authors.lastname: Safdar
authors.forename: E B
authors.initials: EB
authors.lastname: Papadopoulos
authors.forename: J W
authors.initials: JW
authors.lastname: Young
mesh_terms: D000328:Adult; D000935:Antifungal Agents / Q000627:therapeutic use; D001229:Aspergillosis, Allergic Bronchopulmonary / Q000150:complications / Q000188:drug therapy*; D001922:Brain Abscess / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D008271:Mycetoma / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology; D012306:Risk; D021681:Scedosporium / Q000472:pathogenicity*; D014184:Transplantation, Homologous
chemical_list: D000935:Antifungal Agents