title: Successful long-term management of invasive cerebral fungal infection following liver transplantation.
abstract: Central nervous system (CNS) infections after liver transplantation may be fungal in aetiology, with involvement from either common organisms such as Cryptococcus neoformans and Aspergillus spp. as well as less common organisms, such as the Mucorales and Scedosporium spp. Although the mortality of CNS fungal infections was nearly 100% in early series, more recent data has suggested that good outcomes can be achieved. This may be due to both improved diagnostic capabilities, such as the ability to obtain fungal susceptibilities and therapeutic drug levels, and improved therapeutic options, such as the newer triazoles- voriconazole and posaconazole. Due to improved outcomes, issues have now arisen around the long-term tolerability of these agents. The following two cases of invasive cerebral fungal infections following liver transplantation, one with Aspergillus flavus, and the other with Scedosporium boydii/apiospermum highlight the success that can be seen with the modern management of a previously fatal diagnosis. In particular, we highlight the issues around therapeutic monitoring and discontinuation of therapy.
authors.affiliation: Department of Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Madhukar S
authors.initials: MS
authors.lastname: Patel
authors.forename: Alissa J
authors.initials: AJ
authors.lastname: Wright
authors.forename: Rachel
authors.initials: R
authors.lastname: Kohn
authors.forename: James F
authors.initials: JF
authors.lastname: Markmann
authors.forename: Camille N
authors.initials: CN
authors.lastname: Kotton
authors.forename: Parsia A
authors.initials: PA
authors.lastname: Vagefi
mesh_terms: D000935:Antifungal Agents / Q000627:therapeutic use*; D001230:Aspergillus / Q000187:drug effects / Q000302:isolation & purification; D001231:Aspergillus flavus / Q000187:drug effects / Q000302:isolation & purification; D001927:Brain Diseases / Q000000981:diagnostic imaging / Q000188:drug therapy*; D020314:Central Nervous System Fungal Infections / Q000188:drug therapy* / Q000382:microbiology; D004359:Drug Therapy, Combination; D006801:Humans; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D020953:Neuroaspergillosis / Q000188:drug therapy*; D011859:Radiography; D021681:Scedosporium / Q000187:drug effects / Q000302:isolation & purification; D014230:Triazoles / Q000008:administration & dosage; D065819:Voriconazole / Q000008:administration & dosage
chemical_list: D000935:Antifungal Agents; D014230:Triazoles; C101425:posaconazole; D065819:Voriconazole
keywords: Liver transplantation; fungal infection