title: Treatment of refractory cerebral aspergillosis in a liver transplant recipient with voriconazole: case report and review of the literature.
abstract: OBJECTIVE
  Extension of invasive aspergillosis to the central nervous system is associated with high mortality, in part because of poor central nervous system penetration of antifungal drugs. Voriconazole yields fungicidal drug concentrations within the central nervous system, but use of this drug is limited in liver transplant recipients because of hepatotoxicity and drug interactions.
  
  
  METHODS
  We reviewed medical records and antifungal treatment for all liver transplant recipients from 2007 to 2009 who had cerebral aspergillosis (Proven [2]; Probable [1]; Possible [1]) at week 3, 4, 6, and 12 after transplant.
  
  
  METHODS
  A 33-year-old white man underwent orthotopic liver transplant for acute liver failure that was caused by acetaminophen overdosage. Risk factors for fungal infection included major blood loss (8 L), prolonged surgery (9 h), and emergency revision transplant that was done because of nonfunctioning of the primary transplant at 48 hours. He developed postoperative aspergillus pneumonia and invasive aspergillosis of the kidneys, brain, and eye. Treatment with voriconazole and amphotericin B was successful, with moderate residual renal impairment.
  
  
  CONCLUSIONS
  Voriconazole was effective and safe in the treatment of cerebral aspergillosis in this liver transplant recipient.
authors.affiliation: Institute of Liver Studies, King's College Hospital, London, UK. liversurg@live.co.uk
authors.forename: Thomas
authors.initials: T
authors.lastname: Cherian
authors.forename: Alexandros
authors.initials: A
authors.lastname: Giakoustidis
authors.forename: Satoshi
authors.initials: S
authors.lastname: Yokoyama
authors.forename: Michael
authors.initials: M
authors.lastname: Heneghan
authors.forename: John
authors.initials: J
authors.lastname: O'Grady
authors.forename: Mohamed
authors.initials: M
authors.lastname: Rela
authors.forename: Julia
authors.initials: J
authors.lastname: Wendon
authors.forename: D Nigel
authors.initials: DN
authors.lastname: Heaton
authors.forename: Anita
authors.initials: A
authors.lastname: Verma
mesh_terms: D000328:Adult; D000666:Amphotericin B / Q000493:pharmacokinetics / Q000627:therapeutic use; D000935:Antifungal Agents / Q000493:pharmacokinetics / Q000627:therapeutic use; D001228:Aspergillosis / Q000188:drug therapy*; D004359:Drug Therapy, Combination; D004660:Encephalitis / Q000188:drug therapy* / Q000382:microbiology; D006801:Humans; D016031:Liver Transplantation; D008297:Male; D011743:Pyrimidines / Q000493:pharmacokinetics / Q000627:therapeutic use*; D016896:Treatment Outcome; D014230:Triazoles / Q000493:pharmacokinetics / Q000627:therapeutic use*; D065819:Voriconazole
chemical_list: D000935:Antifungal Agents; D011743:Pyrimidines; D014230:Triazoles; D000666:Amphotericin B; D065819:Voriconazole