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Disseminated fusariosis with cerebral involvement in a patient with acute myeloid leukemia: Successful outcome with intrathecal -and systemic antifungal treatment.

Abstract
The outcome of invasive fusariosis in hematological patients is usually dismal, particularly in patients with persistent neutropenia. We report a patient with acute myeloid leukemia (AML) with Fusarium dimerum sinusitis with hematogenic dissemination to the brain. Despite surgical debridements of the sinuses and liposomal amphotericin B, voriconazole and terbinafine, there was progression with cerebral involvement after recovery of neutropenia and with detection of F. dimerum in the cerebrospinal fluid. Topical antifungal treatment with amphotericin B deoxycholate (deoxy-AMB) intrathecally was initiated with administration three times a week. After 99 treatments of intrathecal deoxy-AMB, she had regression of the fusarium CNS lesions and is currently in complete remission from AML. This report supports the use of intrathecal amphotericin B for treatment of CNS fusariosis.
AuthorsMalene Risum, Ulrik Malthe Overgaard, Niclas Rubek, Eva Kannik Haastrup, Rasmus Krøger Hare, Jannik Helweg-Larsen
JournalJournal of infection and chemotherapy : official journal of the Japan Society of Chemotherapy (J Infect Chemother) Vol. 28 Issue 9 Pg. 1324-1328 (Sep 2022) ISSN: 1437-7780 [Electronic] Netherlands
PMID35641412 (Publication Type: Case Reports, Journal Article)
CopyrightCopyright © 2022 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.
Chemical References
  • Antifungal Agents
  • Voriconazole
Topics
  • Antifungal Agents (therapeutic use)
  • Female
  • Fusariosis (diagnosis)
  • Fusarium
  • Humans
  • Leukemia, Myeloid, Acute (complications, drug therapy)
  • Neutropenia (drug therapy)
  • Voriconazole (therapeutic use)

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