Successful therapy of cerebral phaeohyphomycosis due to Ramichloridium mackenziei with the new triazole posaconazole.
Cerebral phaeohyphomycosis caused by Ramichloridium mackenziei is universally fatal. All reported cases with long-term follow-up have indicated 100% mortality despite antifungal therapy and surgical intervention. We describe the case of a 62-year-old patient who underwent renal transplantation and had a cerebral abscess caused by R. mackenziei. The infection progressed despite surgical evacuation and therapy with liposomal amphotericin B, itraconazole, and 5-flucytosine. The patient was subsequently treated with the investigational triazole posaconazole oral suspension, 800 mg/day, in divided doses. Treatment with posaconazole resulted in progressive clinical and radiologic improvement. The patient is alive four years after diagnosis and maintained on posaconazole therapy. This case supports the potential role of this extended-spectrum azole in the treatment of this serious fungal infection of the central nervous system.
Al-Abdely
H M
HM
Section of Infectious Diseases, Department of Medicine, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia. abdely@kfshrc.edu.sa
Alkhunaizi
A M
AM
Al-Tawfiq
J A
JA
Hassounah
M
M
Rinaldi
M G
MG
Sutton
D A
DA
D000935:Antifungal Agents / Q000627:therapeutic use*; D001203:Ascomycota / Q000187:drug effects*; D001927:Brain Diseases / Q000188:drug therapy* / Q000382:microbiology; D020314:Central Nervous System Fungal Infections / Q000188:drug therapy* / Q000382:microbiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000188:drug therapy / Q000382:microbiology; D016896:Treatment Outcome; D014230:Triazoles / Q000627:therapeutic use*
D000935:Antifungal Agents; D014230:Triazoles; C101425:posaconazole