Neuroaspergillosis in an immunocompetent patient successfully treated with voriconazole and a corticosteroid.
Aspergillosis of the central nervous system (CNS) is an uncommon infection, mainly occurring in immunocompromised patients. We report a case of nasocerebral aspergillosis in an immunocompetent patient successfully treated with voriconazole and a corticosteroid. Magnetic resonance imaging (MRI) showed contrast enhancement surrounding the brainstem and cerebellum with intramedullary pontine and cerebellar T2-hyperintense lesions. The patient's symptoms and MRI abnormalities improved after voriconazole and corticosteroid treatment; however, discontinuation of the corticosteroid caused a worsening of the T2-hyperintense lesions, whereas resuming it resulted in its improvement. This suggested that these T2-hyperintense lesions may be due to secondary inflammation caused by aspergillosis and not the aspergillosis itself. We conclude that treatment with a combination of voriconazole and a corticosteroid appears to be effective for the treatment of some patients with CNS aspergillosis.
Hiraga
Akiyuki
A
Department of Neurology, Chiba Rosai Hospital, Chiba. hiragaa@yahoo.co.jp
Uzawa
Akiyuki
A
Shibuya
Mariko
M
Numata
Tsutomu
T
Sunami
Shigeko
S
Kamitsukasa
Ikuo
I
D000368:Aged; D000935:Antifungal Agents / Q000627:therapeutic use*; D001927:Brain Diseases / Q000188:drug therapy* / Q000382:microbiology*; D006801:Humans; D007121:Immunocompetence; D008297:Male; D020953:Neuroaspergillosis / Q000188:drug therapy*; D011743:Pyrimidines / Q000627:therapeutic use*; D012074:Remission Induction; D014230:Triazoles / Q000627:therapeutic use*; D065819:Voriconazole
D000935:Antifungal Agents; D011743:Pyrimidines; D014230:Triazoles; D065819:Voriconazole