title: Cerebral phaeohyphomycosis in an immunodeficient child treated medically with combination antifungal therapy.
abstract: Cerebral phaeohyphomycosis is a rare fungal infection with a poor prognosis when using conventional antifungal therapy in the absence of neurosurgical intervention. We present a case of a pediatric patient with inoperable Cladophialophora bantiana cerebral abscesses. To our knowledge, this child's case is the first reported to be treated with the combination of the newer triazole voriconazole and the new echinocandin caspofungin. Although our patient subsequently died, the natural rapid progression of the disease seemed to be altered by the antifungal combination alone, in the absence of surgery. Despite the fatal outcome for our patient, we encourage other clinicians to try unique medical approaches for this historically life-threatening infection when adjunctive surgery is impossible.
authors.affiliation: Department of Pediatrics, Duke University, Durham, North Carolina 27710, USA.
authors.forename: Jane V
authors.initials: JV
authors.lastname: Trinh
authors.forename: William J
authors.initials: WJ
authors.lastname: Steinbach
authors.forename: Wiley A
authors.initials: WA
authors.lastname: Schell
authors.forename: Joanne
authors.initials: J
authors.lastname: Kurtzberg
authors.forename: Steven S
authors.initials: SS
authors.lastname: Giles
authors.forename: John R
authors.initials: JR
authors.lastname: Perfect
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D000935:Antifungal Agents / Q000627:therapeutic use*; D001203:Ascomycota / Q000302:isolation & purification*; D001922:Brain Abscess / Q000188:drug therapy / Q000382:microbiology*; D001927:Brain Diseases / Q000188:drug therapy / Q000382:microbiology; D000077336:Caspofungin; D002648:Child; D004359:Drug Therapy, Combination; D054714:Echinocandins; D017809:Fatal Outcome; D006801:Humans; D007153:Immunologic Deficiency Syndromes / Q000150:complications*; D055666:Lipopeptides; D008297:Male; D009181:Mycoses / Q000188:drug therapy / Q000382:microbiology; D010455:Peptides; D010456:Peptides, Cyclic; D011743:Pyrimidines / Q000627:therapeutic use*; D014230:Triazoles / Q000627:therapeutic use*; D065819:Voriconazole
chemical_list: D000900:Anti-Bacterial Agents; D000935:Antifungal Agents; D054714:Echinocandins; D055666:Lipopeptides; D010455:Peptides; D010456:Peptides, Cyclic; D011743:Pyrimidines; D014230:Triazoles; D000077336:Caspofungin; D065819:Voriconazole