Cerebral aspergillosis in the critically ill: two cases of successful medical treatment.
OBJECTIVE
Invasive aspergillosis is associated with a poor prognosis, especially in critically ill patients with cerebral involvement. We present two cases of cerebral invasive aspergillosis successfully treated in the intensive care unit with combination antifungal therapies and without surgery.


METHODS
The first patient was a 49-year-old man with rheumatoid arthritis who received corticosteroid and cyclophosphamide treatment and developed pulmonary and cerebral invasive aspergillosis. After failure of voriconazole the patient had a successful outcome with voriconazole and liposomal amphotericin B therapy. The patient returned home after an 8-month hospital stay. The second patient was a 54-year-old woman with pulmonary neoplasia and corticosteroid treatment who developed pulmonary and cerebral invasive aspergillosis. After failure of voriconazole and liposomal amphotericin B therapy the patient had a favorable outcome with liposomal amphotericin B and caspofungin therapy. The patient died 10 months after initial diagnosis of cardiac tamponade unrelated to fungal infection.


CONCLUSIONS
These cases illustrate the improving prognosis of invasive aspergillosis due to the availability of new treatments, especially in cases of cerebral involvement. It also demonstrates that the outcome of critically ill patients requiring mechanical ventilation for invasive aspergillosis can be favorable. The treatment of patients with invasive cerebral aspergillosis in the intensive care setting should be encouraged.
Ehrmann
Stephan
S
Service de Réanimation Médicale Polyvalente, Hôpital Bretonneau, Centre Hospitalier Universitaire de Tours, 37044 Tours cedex 9, France. stephanehrmann@yahoo.co.uk
Bastides
Frédéric
F
Gissot
Valérie
V
Mercier
Emmanuelle
E
Magro
Pascal
P
Bailly
Eric
E
Legras
Annick
A
D000666:Amphotericin B / Q000008:administration & dosage*; D000935:Antifungal Agents / Q000627:therapeutic use*; D001232:Aspergillus fumigatus; D000077336:Caspofungin; D004359:Drug Therapy, Combination; D054714:Echinocandins; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D007362:Intensive Care Units; D055666:Lipopeptides; D008297:Male; D008875:Middle Aged; D020953:Neuroaspergillosis / Q000000981:diagnostic imaging / Q000188:drug therapy*; D010456:Peptides, Cyclic / Q000008:administration & dosage*; D011743:Pyrimidines / Q000008:administration & dosage*; D014057:Tomography, X-Ray Computed; D014230:Triazoles / Q000008:administration & dosage*; D065819:Voriconazole
D000935:Antifungal Agents; D054714:Echinocandins; D055666:Lipopeptides; D010456:Peptides, Cyclic; D011743:Pyrimidines; D014230:Triazoles; C068538:liposomal amphotericin B; D000666:Amphotericin B; D000077336:Caspofungin; D065819:Voriconazole