title: Central nervous system aspergillosis in an immunocompetent patient: cure in a hospice setting with very high-dose itraconazole.
abstract: Aspergillosis of the central nervous system (CNS) is a rare condition with exceedingly high mortality. This study describes the case of an immunocompetent 42-year-old man with a history of intravenous drug use and hepatitis C who developed multiple Aspergillus lesions in the cerebellum. Despite neurosurgery and antifungal therapy with amphotericin B, he had a protracted hospital course with multiple complications, eventually developing cognitive and motor impairment due to progressive cerebellar lesions. After transfer to hospice and palliative care service, oral itraconazole was escalated to 1600 mg/day with the hope of palliating headache, nausea, and cognitive impairment. Remarkably, the patient stabilized and improved over time. After 14 months, this unprecedented high-dose regimen was discontinued, and the patient was discharged home with only mild cerebellar motor impairment.
authors.affiliation: Laguna Honda Hospice & Palliative Care Service, Laguna Honda Hospital, San Francisco, California, USA.
authors.forename: Akilesh
authors.initials: A
authors.lastname: Palanisamy
authors.forename: Stephanie D
authors.initials: SD
authors.lastname: Chao
authors.forename: Michelle
authors.initials: M
authors.lastname: Fouts
authors.forename: Derek
authors.initials: D
authors.lastname: Kerr
mesh_terms: D000328:Adult; D000935:Antifungal Agents / Q000627:therapeutic use; D001232:Aspergillus fumigatus; D002526:Cerebellar Diseases / Q000188:drug therapy / Q000382:microbiology* / Q000601:surgery / Q000628:therapy*; D017051:Hospice Care / Q000379:methods*; D006801:Humans; D007121:Immunocompetence; D017964:Itraconazole / Q000627:therapeutic use; D008297:Male; D020953:Neuroaspergillosis / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000935:Antifungal Agents; D017964:Itraconazole