文献简介

出版社:Medical Mycology

作  者:SOPHIA KOO, MICHAEL KLOMPAS & FRANCISCO M. MARTY

编  号:10.3109/13693780903471081

关键字:Fonsecaea monophora, cerebral phaeohyphomycosis, beta-glucan, voriconazole

年  份:2010   点击量:856

文献摘要

  We report a case of Fonsecaea monophora cerebral phaeohyphomycosis successfully treated with surgical excision and voriconazole monotherapy in a patient receiving main- tenance immunosuppression therapy for 8 years after cadaveric renal transplantation. She presented with a severe frontal headache in the absence of any constitutional or neurologic symptoms. Brain magnetic resonance imaging showed an irregular 3.1  3.4 cm ring-enhancing lesion in her left frontal lobe. The patient underwent craniotomy and resection of her mass, with intraoperative spillage of some of her abscess contents into her lateral ventricle. Histopathology of her resected mass showed necrotic fragments of brain parenchyma with granulomatous infl ammation and numerous pigmented fungal forms. A mold, recovered from cultures inoculated with portions of her brain resec- tion specimen, was later defi nitively identifi ed as Fonsecaea monophora. Initial serum (1→3) β-D-glucan (BG) levels exceeded 500 pg/ml. The patient received voriconazole, which she tolerated well, without recurrent headaches or abscess formation noted on serial brain imaging. Her BG declined to 31 pg/ml one year following her abscess resection. She discontinued antifungal therapy after an 18-month treatment course, and has remained free of any clinical or radiographic evidence of recurrent abscess  formation three years later.