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Cerebral aspergillosis in the critically ill: two cases of successful medical treatment

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Abstract

Objective

Invasive aspergillosis is associated with a poor prognosis, especially in critically ill patients with cerebral involvement. We present two cases of cerebral invasive aspergillosis successfully treated in the intensive care unit with combination antifungal therapies and without surgery.

Case presentation

The first patient was a 49-year-old man with rheumatoid arthritis who received corticosteroid and cyclophosphamide treatment and developed pulmonary and cerebral invasive aspergillosis. After failure of voriconazole the patient had a successful outcome with voriconazole and liposomal amphotericin B therapy. The patient returned home after an 8-month hospital stay. The second patient was a 54-year-old woman with pulmonary neoplasia and corticosteroid treatment who developed pulmonary and cerebral invasive aspergillosis. After failure of voriconazole and liposomal amphotericin B therapy the patient had a favorable outcome with liposomal amphotericin B and caspofungin therapy. The patient died 10 months after initial diagnosis of cardiac tamponade unrelated to fungal infection.

Discussions

These cases illustrate the improving prognosis of invasive aspergillosis due to the availability of new treatments, especially in cases of cerebral involvement. It also demonstrates that the outcome of critically ill patients requiring mechanical ventilation for invasive aspergillosis can be favorable. The treatment of patients with invasive cerebral aspergillosis in the intensive care setting should be encouraged.

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Acknowledgements

The authors thank Miss Andrea Pritzker for review of the final manuscript.

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Authors and Affiliations

  1. Service de Réanimation Médicale Polyvalente, Hôpital Bretonneau, Centre Hospitalier Universitaire de Tours, 37044, Tours cedex 9, France

    Stephan Ehrmann, Valérie Gissot, Emmanuelle Mercier & Annick Legras

  2. Service de Médecine Interne et de Maladies Infectieuses, Hôpital Bretonneau, Centre Hospitalier Universitaire de Tours, 37044, Tours cedex 9, France

    Frédéric Bastides

  3. Service de Pneumologie, Hôpital Bretonneau, Centre Hospitalier Universitaire de Tours, 37044, Tours cedex 9, France

    Pascal Magro

  4. Laboratoire de Mycologie et Parasitologie, Hôpital Bretonneau, Centre Hospitalier Universitaire de Tours, 37044, Tours cedex 9, France

    Eric Bailly

Authors
  1. Stephan Ehrmann
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  2. Frédéric Bastides
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  3. Valérie Gissot
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  4. Emmanuelle Mercier
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  5. Pascal Magro
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  6. Eric Bailly
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  7. Annick Legras
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Correspondence to Stephan Ehrmann.

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Ehrmann, S., Bastides, F., Gissot, V. et al. Cerebral aspergillosis in the critically ill: two cases of successful medical treatment. Intensive Care Med 31, 738–742 (2005). https://doi.org/10.1007/s00134-005-2605-5

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  • DOI: https://doi.org/10.1007/s00134-005-2605-5

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