Use of external ventriculostomy and intrathecal anti-fungal treatment in cerebral mucormycotic abscess.
Mucormycosis is an invasive fungal infection associated with a high mortality. Cerebral mucor abscesses can result secondary to rhinocerebral or hematogenous spread. Amphotericin B, posaconazole, and aggressive surgical resection are the hallmarks of treatment. While amphotericin is typically administered intravenously, less is known about the use of intrathecal amphotericin B. We describe a 42-year-old man who developed a cerebellar mucor abscess after undergoing hematopoietic stem cell transplant for the treatment of myelodysplastic syndrome. In the post-operative period he was admitted to the neurocritical care unit and received liposomal amphotericin B intravenously and through an external ventricular drain. This patient demonstrates that utilization of an external ventricular drain for intrathecal antifungal therapy in the post-operative period may warrant further study in patients with difficult to treat intracranial fungal abscesses.
Department of Neurosurgery, Massachusetts General Hospital, 55 Fruit Street, WACC 745, Boston, MA 02115, USA; Harvard Medical School, Boston, MA, USA.
Benjamin L
BL
Grannan
Department of Neurosurgery, Massachusetts General Hospital, 55 Fruit Street, WACC 745, Boston, MA 02115, USA; Harvard Medical School, Boston, MA, USA.
Vijay
V
Yanamadala
Department of Neurosurgery, Massachusetts General Hospital, 55 Fruit Street, WACC 745, Boston, MA 02115, USA; Harvard Medical School, Boston, MA, USA.
Andrew S
AS
Venteicher
Department of Neurosurgery, Massachusetts General Hospital, 55 Fruit Street, WACC 745, Boston, MA 02115, USA; Harvard Medical School, Boston, MA, USA. Electronic address: walcott.brian@mgh.harvard.edu.
Brian P
BP
Walcott
Department of Neurosurgery, Massachusetts General Hospital, 55 Fruit Street, WACC 745, Boston, MA 02115, USA; Harvard Medical School, Boston, MA, USA.
John C
JC
Barr
D000328:Adult; D000666:Amphotericin B / Q000008:administration & dosage*; D000935:Antifungal Agents / Q000008:administration & dosage*; D001921:Brain / Q000187:drug effects / Q000473:pathology / Q000601:surgery; D001922:Brain Abscess / Q000188:drug therapy* / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D005500:Follow-Up Studies; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects; D006801:Humans; D007278:Injections, Spinal; D018810:Magnetic Resonance Angiography; D008297:Male; D009091:Mucormycosis / Q000188:drug therapy* / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D009190:Myelodysplastic Syndromes / Q000628:therapy; D014696:Ventriculostomy
D000935:Antifungal Agents; D000666:Amphotericin B
Amphotericin; External ventricular drain; Intrathecal; Mucormycosis; Neurocritical care