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Post-traumatic intracranial epidural Aspergillus fumigatus abscess
V Letscher1, R Herbrecht, J Gaudias
1Institut de Parasitologie et de Pathologie Tropicale, Strasbourg, France.
Summary
An immunocompetent patient developed an intracranial epidural abscess caused by Aspergillus fumigatus after surgery. Successful treatment involved surgical drainage, bone resection, and antifungal therapy with amphotericin B and itraconazole.
Area of Science:
- Mycology
- Neurosurgery
- Infectious Diseases
Background:
- Intracranial epidural abscesses are rare, particularly in immunocompetent individuals.
- Post-traumatic frontal craniotomy presents a potential risk for fungal infections.
Observation:
- A 20-year-old immunocompetent male developed an Aspergillus fumigatus epidural abscess following frontal craniotomy.
- The infection involved the frontal bone and subcutaneous cellulitis, with the dura mater encapsulating the abscess.
Findings:
- Initial treatment included surgical drainage, necrotic bone resection, and liposomal amphotericin B.
- A second, unsuspected abscess required further surgical evacuation and local amphotericin B instillation.
- Long-term management involved oral itraconazole, leading to a successful, infection-free outcome after 3 years.
Implications:
- This case highlights the possibility of Aspergillus fumigatus causing intracranial epidural abscesses in immunocompetent hosts.
- Aggressive surgical intervention combined with targeted antifungal therapy is crucial for managing such complex infections.
- Multifaceted treatment strategies, including local drug delivery, may be necessary for complete eradication.