Successful Multimodal Therapy with Intracerebral Liposomal Amphotericin B and Systemic High-Dose Isavuconazole in Proven Disseminated Aspergillosis

Abstract

We report the case of a 32-year-old man receiving chemotherapeutics for an acute B-lymphoblastic leukemia who developed proven cerebral and pulmonary aspergillosis with Aspergillus flavus. Because of progressive fungal disease with neurological deterioration despite adequate systemic antifungal therapy and surgical debridement, intracerebral administration of liposomal amphotericin B was initiated at 5 mg twice weekly. This led to improvement of the cerebral infection. Surgical debridement of a pleural Aspergillus empyema was necessary, and pleural trough level of isavuconazole was found to be subtherapeutic despite adequate blood trough levels, which led us to increase the dose of isavuconazole. We conclude that intralesional amphotericin B might be beneficial at 5 mg twice weekly in cerebral aspergillosis if systemic antifungals and surgical debridement fail. In Aspergillus empyema, measurement of pleural isavuconazole trough levels should be considered.

Case report: Successful combination therapy with isavuconazole and amphotericin B in treatment of disseminated Candida tropicalis infection

“…Cases of disseminated mucormycosis in children with leukemia, treated successfully with ISA and liposomal AmB, have been reported ( 25 , 26 ). Feys et al reported a case of disseminated aspergillosis involving CNS and lung, successfully treated by intracerebral liposomal AmB combined with intravenous ISA ( 27 ). Furthermore, there have been cases of fungal endocarditis successfully treated with dual antifungal therapy using liposomal AmB and ISA ( 28 , 29 ).…”

Data_Sheet_2.docx

“…Cases of disseminated mucormycosis in children with leukemia, treated successfully with ISA and liposomal AmB, have been reported (25,26). Feys et al reported a case of disseminated aspergillosis involving CNS and lung, successfully treated by intracerebral liposomal AmB combined with intravenous ISA (27). Furthermore, there have been cases of fungal endocarditis successfully treated with dual antifungal therapy using liposomal AmB and ISA (28,29).…”

Data_Sheet_4.docx

“…Cases of disseminated mucormycosis in children with leukemia, treated successfully with ISA and liposomal AmB, have been reported (25,26). Feys et al reported a case of disseminated aspergillosis involving CNS and lung, successfully treated by intracerebral liposomal AmB combined with intravenous ISA (27). Furthermore, there have been cases of fungal endocarditis successfully treated with dual antifungal therapy using liposomal AmB and ISA (28,29).…”