title: Refractory candidal meningitis in an immunocompromised patient cured by caspofungin.
abstract: Candidal meningitis is a rare infectious disease that usually leads to substantial morbidity and mortality. We present a case of candidal meningitis refractory to systemic antifungal therapy (amphotericin B and fluconazole). A 63-year-old female with lymphoblastic lymphoma and myelodysplasia with leukemia transformation developed prolonged fever and headache on the seventh day following intrathecal prophylactic chemotherapy. A lumbar puncture showed neutrophilic pleocytosis, and a cerebrospinal fluid culture yielded Candida albicans. The clinical course was complicated by brain edema, subarachnoid hemorrhage, and hydrocephalus. Parenteral therapy with amphotericin B alone or amphotericin B in combination with fluconazole or intrathecal administration of amphotericin B failed to eradicate C. albicans in the cerebrospinal fluid. After 7 days of caspofungin therapy, however, the cerebrospinal fluid became sterile and the patient gradually regained consciousness. She was discharged 1 month after completing 4 weeks of caspofungin therapy. There were two critical issues we thought to be relevant to the favorable outcome of this case. First, isolation of C. albicans was achieved by inoculating enriched liquid medium with cerebrospinal fluid. Second, there is a potential therapeutic benefit of caspofungin in treating a fungal infection of the central nervous system.
authors.affiliation: Department of Internal Medicine, National Cheng Kung University Hospital, No. 138, Sheng Li Rd., 704 Tainan, Taiwan.
authors.forename: Kung-Hung
authors.initials: KH
authors.lastname: Liu
authors.forename: Chi-Jung
authors.initials: CJ
authors.lastname: Wu
authors.forename: Chen-Hsi
authors.initials: CH
authors.lastname: Chou
authors.forename: Hsin-Chun
authors.initials: HC
authors.lastname: Lee
authors.forename: Nan-Yao
authors.initials: NY
authors.lastname: Lee
authors.forename: Shao-Tsung
authors.initials: ST
authors.lastname: Hung
authors.forename: Wen-Chien
authors.initials: WC
authors.lastname: Ko
mesh_terms: D000935:Antifungal Agents / Q000627:therapeutic use*; D002176:Candida albicans / Q000187:drug effects / Q000302:isolation & purification*; D002177:Candidiasis / Q000188:drug therapy* / Q000382:microbiology; D000077336:Caspofungin; D054714:Echinocandins; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D055666:Lipopeptides; D016921:Meningitis, Fungal / Q000188:drug therapy* / Q000382:microbiology; D008875:Middle Aged; D010456:Peptides, Cyclic / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D000935:Antifungal Agents; D054714:Echinocandins; D055666:Lipopeptides; D010456:Peptides, Cyclic; D000077336:Caspofungin