Long term outcome of medical and surgical co-management of craniospinal aspergillosis in an immunocompromised patient

Dipu Sathyapalan; Sabarish Balachandran; Anil Kumar; Bindu Mangalath Rajamma; Ashok Pillai; Vidya P Menon

doi:10.1016/j.mmcr.2016.11.008

Long term outcome of medical and surgical co-management of craniospinal aspergillosis in an immunocompromised patient

Med Mycol Case Rep. 2016 Nov 29:14:33-37. doi: 10.1016/j.mmcr.2016.11.008. eCollection 2016 Dec.

Authors

Dipu Sathyapalan¹, Sabarish Balachandran², Anil Kumar³, Bindu Mangalath Rajamma⁴, Ashok Pillai⁵, Vidya P Menon¹

Affiliations

¹ Department of General Medicine, Amrita Institute of Medical Sciences and Research Centre, Ponekkara, Kochi 682041, India.
² Department of Emergency Medicine, Amrita Institute of Medical Sciences and Research Centre, Ponekkara, Kochi 682041, India.
³ Department of Microbiology, Amrita Institute of Medical Sciences and Research Centre, Ponekkara, Kochi 682041, India.
⁴ Department of Pathology, Amrita Institute of Medical Sciences and Research Centre, Ponekkara, Kochi 682041, India.
⁵ Department of Neurosurgery, Amrita Institute of Medical Sciences and Research Centre, Ponekkara, Kochi 682041, India.

Abstract

35 yr old steroid dependent lady with Pulmonary TB underwent debridement of epidural abscess & posterior stabilization for paraparesis. With histopathology and cultures showing Aspergillus fumigatus, voricanozole was started. By the fourth week, she developed persistent fever, and altered mental status. Brain MRI and CSF study including multiplex PCR evaluation confirmed cerebral aspergillosis. Voricanozole was changed to intravenous lipid complex Amphotericin B to achieve sustained clinical and radiological response after six months of therapy.

Keywords: CNS Aspergillosis; CNS infections in immunocompromised; Mycobacterium tuberculosis; Spinal Aspergillosis.