Current approaches to management of cerebral fungal infection in pediatric patients with hematologic disorders.
We report 2 pediatric cases of cerebral fungal infection. A patient with severe aplastic anemia developed an Aspergillus species brain abscess and pulmonary aspergillosis after peripheral blood stem cell transplantation. Despite administration of micafungin, amphotericin B, and flucytosine, the patient died 2 months after the transplantation because of underlying pulmonary aspergillosis. Another patient with acute myelogenous leukemia developed a huge brain abscess with histopathologic findings suspicious of mucormycosis. This patient was cured with combination therapy of antifungal agents and intensive surgery, without sequelae. It is important to perform aggressive multimodality treatment, when indicated, including surgical intervention, even if in myelosuppression.
Sato
Tomonobu
T
Department of Pediatrics, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan. t-satou@jacls.jp
Kaneda
Makoto
M
Ichikawa
Mizuho
M
Suzuki
Daisuke
D
Nakagawa
Atsuko
A
Kobayashi
Ryoji
R
D000293:Adolescent; D000666:Amphotericin B / Q000008:administration & dosage; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D000935:Antifungal Agents / Q000008:administration & dosage; D001228:Aspergillosis / Q000175:diagnosis* / Q000382:microbiology / Q000628:therapy; D020314:Central Nervous System Fungal Infections / Q000175:diagnosis* / Q000382:microbiology / Q000628:therapy; D002648:Child; D004338:Drug Combinations; D054714:Echinocandins / Q000008:administration & dosage; D017809:Fatal Outcome; D005260:Female; D005437:Flucytosine / Q000008:administration & dosage; D005500:Follow-Up Studies; D006084:Graft Rejection; D006402:Hematologic Diseases / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D055666:Lipopeptides; D008074:Lipoproteins / Q000008:administration & dosage; D008279:Magnetic Resonance Imaging; D008297:Male; D000077551:Micafungin; D009091:Mucormycosis / Q000175:diagnosis* / Q000628:therapy; D036102:Peripheral Blood Stem Cell Transplantation / Q000009:adverse effects; D012074:Remission Induction; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D000935:Antifungal Agents; D004338:Drug Combinations; D054714:Echinocandins; D055666:Lipopeptides; D008074:Lipoproteins; D000666:Amphotericin B; D005437:Flucytosine; D000077551:Micafungin