Voriconazole brain tissue levels in rhinocerebral aspergillosis in a successfully treated young woman.
Invasive aspergillosis of the central nervous system has a mortality rate exceeding 90%. We describe a 29-year-old woman with a medical history of chronic polyarthritis who developed a proven rhinocerebral Aspergillus fumigatus infection refractory to first-line treatment with liposomal amphotericin B. The patient responded successfully to salvage combination treatment with voriconazole and caspofungin. Furthermore, for the first time, voriconazole levels in an intracerebral abscess were measured in this patient undergoing voriconazole oral therapy.
Elter
Thomas
T
1st Department of Internal Medicine, University of Cologne, 50924 Cologne, Germany.
Sieniawski
Michal
M
Gossmann
Axel
A
Wickenhauser
Claudia
C
Schröder
Ursula
U
Seifert
Harald
H
Kuchta
Johannes
J
Burhenne
Jürgen
J
Riedel
Klaus-Dieter
KD
Fätkenheuer
Gerd
G
Cornely
Oliver A
OA
D000328:Adult; D000666:Amphotericin B / Q000627:therapeutic use; D000935:Antifungal Agents / Q000493:pharmacokinetics / Q000627:therapeutic use*; D001168:Arthritis / Q000150:complications; D001232:Aspergillus fumigatus / Q000302:isolation & purification; D001921:Brain / Q000378:metabolism* / Q000382:microbiology; D001922:Brain Abscess / Q000188:drug therapy* / Q000378:metabolism / Q000382:microbiology; D000077336:Caspofungin; D002853:Chromatography, Liquid; D054714:Echinocandins; D005260:Female; D006801:Humans; D055666:Lipopeptides; D008279:Magnetic Resonance Imaging; D013058:Mass Spectrometry; D020953:Neuroaspergillosis / Q000188:drug therapy* / Q000378:metabolism / Q000382:microbiology; D010254:Paranasal Sinus Diseases / Q000188:drug therapy* / Q000378:metabolism / Q000382:microbiology; D010456:Peptides, Cyclic / Q000627:therapeutic use; D011743:Pyrimidines / Q000493:pharmacokinetics / Q000627:therapeutic use*; D013211:Staphylococcus aureus / Q000302:isolation & purification; D014230:Triazoles / Q000493:pharmacokinetics / Q000627:therapeutic use*; 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