Control of proven pulmonary and suspected CNS aspergillus infection with itraconazole in a patient with chronic granulomatous disease

Abstract

An 11-year-old boy with chronic granulomatous disease caused by cytochrome b deficiency developed right upper lung lobe aspergillosis. Intracerebral lesions developed on maximum doses of flucytosine and amphotericin B. Treatment with 16 mg/kg oral itraconazole was followed by a dramatic clinical improvement and almost complete disappearance of the intracerebral lesions. Plasma itraconazole levels were between 40 and 3440 ng/ml depending on concomitant medication. Toxicity was restricted to transient elevation of alkaline phosphatase and gamma glutamyl transferase. We conclude that further trials with itraconazole are justified in high risk patients in whom conventional therapy has failed.

Successful Treatment of Aspergillus Brain Abscess with Itraconazole and Interferon- in a Patient with Chronic Granulomatous Disease

“…In that report, branching septate hyphae were seen on microscopic examination of the abscess material, but cultures did not grow Aspergillus. Kolb et al [5] also described a child with CGD in whom Aspergillus brain abscess was strongly suspected but was not proven by microscopic exam or culture. Thus, the present patient represents the first report of cultureproven Aspergillus brain abscess in a child with CGD.…”

Cerebral aspergillosis and pulmonary tuberculosis in a child with chronic granulomatous disease

“…Although these patients have an increased susceptibility to tuberculosis (TB), reports of TB in CGD are rare. [ 4 7 ] In developing countries, where TB is endemic, there is a tendency among physicians to treat patients without a prior microbiological or pathological confirmation of the diagnosis. This can lead to a delay in the diagnosis of other potentially fatal infections.…”