[Aspergillus mastoiditis in infected granulomatosis--a case report]

An 11-year old boy with chronic granulomatous disease due to cytochrome B deficiency developed pulmonary aspergillosis proven by culture in his upper right lobe (upper lobe resection). In spite of maximum doses of flucytosin/amphotericin B combination, he developed focal seizures associated with three intracerebral lesions and a lesion in the area of the right mastoid. Imaging methods (X-ray Schüller, CT, MRT) demonstrated the defects. Mastoidectomy showed blue purulent but sterile necrosis. The antimycotic therapy with the Flucytosin/Amphotericin B combination was stopped and replaced by a new drug, itraconazole. After a short time the boy felt much better. Even the intracerebral lesions became smaller. We conclude that both the surgical and the conservative therapy with a new antimycotic are the reason for this result.