Use of external ventriculostomy and intrathecal anti-fungal treatment in cerebral mucormycotic abscess

J Clin Neurosci. 2014 Oct;21(10):1819-21. doi: 10.1016/j.jocn.2014.01.008. Epub 2014 May 19.

Abstract

Mucormycosis is an invasive fungal infection associated with a high mortality. Cerebral mucor abscesses can result secondary to rhinocerebral or hematogenous spread. Amphotericin B, posaconazole, and aggressive surgical resection are the hallmarks of treatment. While amphotericin is typically administered intravenously, less is known about the use of intrathecal amphotericin B. We describe a 42-year-old man who developed a cerebellar mucor abscess after undergoing hematopoietic stem cell transplant for the treatment of myelodysplastic syndrome. In the post-operative period he was admitted to the neurocritical care unit and received liposomal amphotericin B intravenously and through an external ventricular drain. This patient demonstrates that utilization of an external ventricular drain for intrathecal antifungal therapy in the post-operative period may warrant further study in patients with difficult to treat intracranial fungal abscesses.

Keywords: Amphotericin; External ventricular drain; Intrathecal; Mucormycosis; Neurocritical care.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Adult
  • Amphotericin B / administration & dosage*
  • Antifungal Agents / administration & dosage*
  • Brain / drug effects
  • Brain / pathology
  • Brain / surgery
  • Brain Abscess / drug therapy*
  • Brain Abscess / etiology
  • Brain Abscess / pathology
  • Brain Abscess / surgery*
  • Follow-Up Studies
  • Hematopoietic Stem Cell Transplantation / adverse effects
  • Humans
  • Injections, Spinal
  • Magnetic Resonance Angiography
  • Male
  • Mucormycosis / drug therapy*
  • Mucormycosis / etiology
  • Mucormycosis / pathology
  • Mucormycosis / surgery*
  • Myelodysplastic Syndromes / therapy
  • Ventriculostomy

Substances

  • Antifungal Agents
  • Amphotericin B