Oral voriconazole for invasive fungal skull base infection

Parsonage, M.; Stafford, Nicholas D.; Lillie, Patrick; Moss, Peter; Barlow, Gavin; Thaker, Hiten

doi:10.1017/s0022215109992507

Cited by 6 publications

(6 citation statements)

References 14 publications

(28 reference statements)

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“…Recommendations have ranged from medical management alone to radical surgery with adjuvant chemotherapy (4, 27, 28, 35). Combination antifungal therapy with amphotericin B and itraconazole, voriconazole, or micafungin with or without surgical intervention has been used successfully to control the infection in some cases (3, 19, 26, 28, 34, 35). Voriconazole recently has become the drug of choice for invasive aspergillosis because patients demonstrate a better tolerance for it and because of its lower toxicity compared with amphoterecin B (3); the overall response rate to antifungal chemotherapy ranges from 40% to 60% (39).…”

Section: Discussionmentioning

confidence: 99%

Acute Chiasmal Abscess Resulting from Perineural Extension of Invasive Sino-Orbital Aspergillosis in an Immunocompetent Patient

et al. 2014

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OBJECTIVE Intracranially invasive sino-orbital aspergillosis is a rare entity seen predominantly in immunocompromised individuals. We report a unique case of an acute chiasmal abscess resulting from perineural extension of an indolent invasive sino-orbital aspergillosis in an immunocompetent patient. CASE DESCRIPTION A 61-year-old healthy Ukrainian man presented with severe left retro-orbital pain and a gradual ipsilateral monocular vision loss with rapid progression to a contralateral temporal visual field cut. He was found to have an intracranially invasive sino-orbital Aspergillus fumigatus infection with perineural extension along the optic nerve complicated by an acute chiasmal abscess. RESULTS The patient was managed with surgical debridement and adjuvant antifungal chemotherapy. The patient’s life and vision were preserved. CONCLUSIONS The case demonstrates that it is possible to successfully control advanced intracranial aspergillosis with tissue-sparing surgery and adjuvant antifungal chemotherapy in immunocompetent individuals.

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Section: Discussionmentioning

confidence: 99%

Acute Chiasmal Abscess Resulting from Perineural Extension of Invasive Sino-Orbital Aspergillosis in an Immunocompetent Patient

et al. 2014

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“…Management of invasive sino-orbital Aspergillosis in immunocompetent patients remains controversial. Management modality ranges from medical management 12,13 alone to radical surgery with adjuvant chemotherapy. Combination of antifungal agents has been used successfully 14,15 to control infection in some studies.…”

Section: Discussionmentioning

confidence: 99%

Invasive Sino-Orbital Aspergillosis in an Immunocompetent Patient

Okolo

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Onyedibe

et al. 2019

J BioMed Res Clin Pract

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Invasive aspergillosis that involves intra-orbital and intracranial extension occurs in immunodeficient and immunocompetent patients resulting in significant morbidity and mortality. We report the case of a 38year old farmer who had recurrent fronto-ethmoidal mucocoele and proptosis of the left eye. She presented with a history of hypertension and no other significant findings on examination. Computer tomography scan of the brain showed a left fronto-orbital uniform contrast-enhancing extra-axial lesion with thickened peripheral capsule and an associated left fronto-orbital skull defect. Cerebrospinal fluid analysis did not show any sign of infection. Intra-operative biopsy sample showed cheesy material which on culture grew Aspergillus species that was identified further using molecular methods. Antifungal agents were used to treat the patient. The present case strongly suggests that it is possible to control intracranial aspergillosis with a combination of surgery and antifungal chemotherapy.

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“…Parize et al described a series of patients with Aspergillus necrotising otitis externa who were successfully treated with extensive surgical debridement and voriconazole 19 . Other reports include a case of nasocerebral aspergillosis that was successfully treated with voriconazole and steroids without the need for surgery, 20 and a case of invasive rhinogenic skull base disease managed with oral voriconazole alone with substantial cost savings 21 . Although our patient clinically suffered from petrous apicitis, we successfully treated him without recourse to apicectomy, and the cerebral abscess resolved with voriconazole therapy.…”

Section: Discussionmentioning

confidence: 99%