Local Administration of Amphotericin B Against Aspergilloma in the Prepontine Cistern-Case Report-

Abstract

A 21-year-old man presented with aspergilloma in the prepontine cistern that developed after treatment for cerebellar hematoma following rupture of an arteriovenous malformation. He became bedridden with neurological signs of tetraparesis, disturbed ocular movement, and bulbar palsy, despite alert consciousness. Repeat magnetic resonance imaging 1 year later revealed a space-occupying lesion in the prepontine cistern along the clivus. This multilobular enhanced mass lesion gradually enlarged towards the brainstem over the following 4 years, resulting in loss of spontaneous breathing and dependence on a mechanical respirator. Surgical treatment via a lateral suboccipital approach was selected to reduce the size of the mass lesion and confirm the diagnosis. Histological examination revealed the presence of Aspergillus fumigatus. Treatment with amphotericin B (1 mg/kg/day) and fluconazole (100 mg/kg/day) injected into the peripheral veins was initiated, but was stopped due to the appearance of renal dysfunction. An Ommaya tube was then inserted into the prepontine cistern via a transsylvian approach to provide high concentrations of amphotericin B around the granulomatous lesion. He gradually improved, corresponding to the decreased size of the aspergilloma just after surgery. Surgical reduction of granuloma combined with local administration of antifungal agent is a good treatment option in patients with aspergilloma refractory to systemic administration.

Cerebral aspergillosis in a patient with leprosy and diabetes: a case report

“…Nabika et al [ 36 ] reported that surgical reduction of aspergilloma combined with local administration of antifungal was a good treatment option, corroborating the present study. According to Pianetti et al [ 25 ], fungal infections observed as a mass should be treated by aggressive surgical resection.…”

Successful Treatment of Cerebral Aspergillosis in a Patient with Acquired Immune Deficiency Syndrome

“…Surgery not only afforded the opportunity to address the patient's symptoms in the immediate term, but also provided biopsy material that guided further management to ensure a long-term, uneventful recovery. Our strategy was consistent with that of Nabika and colleagues (6), who adopted an invasive approach to treating a patient with HIV infection and an aspergilloma in the prepontine cistern, and underlines the importance of diagnosing and treating cerebral aspergillosis promptly. As cases are rare, there is little evidence to guide clinical decision-making when treating these life-threatening superinfections, with a particular deficit of outcome data.…”

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

“…This prompted us to start intralesional liposomal amphotericin B administration via an Ommaya reservoir, in conjunction with continued systemic therapy with isavuconazole. A small number of cases have reported intralesional amphotericin B administration for cerebral aspergillosis, administering liposomal amphotericin B at a dose of 1 to 3 mg once weekly [ 5 , 16 , 17 ]. We chose to administer the antifungal twice weekly and at a dose of 5 mg (a scheme that has been proposed by Schauwvlieghe et al but had never been tested in practice) [ 5 ].…”