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Treatment of Scedosporium apiospermum brain abscesses with posaconazole

Ingo K Mellinghoff1, Drew J Winston, Geoffrey Mukwaya

  • 1Division of Hematology-Oncology, Department of Medicine, University of California Los Angeles School of Medicine, Los Angeles, CA, 90095, USA.

Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America
|May 29, 2002
PubMed

Insights

Scedosporium apiospermum brain abscesses in an acute lymphoblastic leukemia patient did not respond to standard treatments. Posaconazole monotherapy achieved complete resolution of these multiple fungal brain infections.

Area of Science:

  • Mycology
  • Infectious Diseases
  • Neurology

Background:

  • Acute lymphoblastic leukemia (ALL) patients are immunocompromised, increasing susceptibility to opportunistic infections.
  • Scedosporium apiospermum is an emerging fungal pathogen causing severe infections, particularly in immunocompromised individuals.
  • Brain abscesses due to Scedosporium apiospermum are rare but life-threatening.

Observation:

  • A 41-year-old male with ALL presented with multiple Scedosporium apiospermum brain abscesses.
  • The patient's condition worsened despite surgical intervention and treatment with itraconazole, amphotericin B, and ketoconazole.
  • Invasive fungal infections require prompt and effective therapeutic strategies.

Findings:

  • Posaconazole monotherapy led to the complete resolution of multiple Scedosporium apiospermum brain abscesses.
  • This case highlights the potential efficacy of posaconazole in treating refractory Scedosporium brain infections.
  • Antifungal resistance is a significant concern in managing invasive mycoses.

Implications:

  • Posaconazole may represent a valuable therapeutic option for Scedosporium apiospermum brain abscesses, especially in cases resistant to other antifungals.
  • Further research is warranted to establish optimal treatment protocols for Scedosporium infections in immunocompromised hosts.
  • Early diagnosis and targeted antifungal therapy are crucial for improving outcomes in patients with invasive fungal sinusitis.

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