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• W3092016145 abstract "A 69-year-old man with newly diagnosed B-precursor acute lymphoblastic leukemia (B-ALL) had impaired consciousness on day 24 of remission induction therapy, with a Glasgow Coma Scale (GCS) score of E4V4M6. Serum beta-d-glucan (61.0 pg/μl) and Aspergillus galactomannan antigens in the serum and cerebrospinal fluid (CSF) (both ≥5.0) were elevated. Computed tomography showed a nodule in the left lung. Magnetic resonance imaging (MRI) revealed multiple brain lesions, and a brain biopsy confirmed aspergillosis (Figure 1) according to the updated invasive fungal disease definition (Donnelly et al., 2020Donnelly J.P. Chen S.C. Kauffman C.A. Steinbach W.J. Baddley J.W. Verweij P.E. et al.Revision and update of the consensus definitions of invasive fungal disease from the European organization for research and treatment of cancer and the Mycoses Study Group Education and Research Consortium.Clin Infect Dis. 2020; 71: 1367-1376Crossref PubMed Scopus (664) Google Scholar). CSF culture on day 26 was negative. Prophylactic itraconazole was switched to intravenous liposomal amphotericin B (L-AMB, 5 mg/kg/day), but his consciousness deteriorated rapidly on day 45 (GCS E3V3M5). Brain MRI revealed intraventricular rupture of brain abscess (IVRBA, Figure 2). He was deemed unfit for surgical intervention; L-AMB was switched to intravenous voriconazole (12 mg/kg/day). Consequently, his condition and consciousness ameliorated, and brain abscesses were well controlled thereafter. Although he achieved complete remission on day 40, he died of relapsed disease 9 months after the onset of B-ALL.Figure 2Intraventricular rupture of the right temporal lobe lesion. (A) Brain MRI (FLAIR) on day 45 showing multiple abscesses with ventricular perforation. (B) Diffusion-weighted image from the brain MRI on day 45 revealing the accumulation of sediments in the right ventricle (arrow). The WBC count in the cerebrospinal fluid increased from 10/μl (day 26) to 235/μl (day 45). (MRI, magnetic resonance imaging; FLAIR, fluid-attenuated inversion recovery; WBC, white blood cell.).View Large Image Figure ViewerDownload Hi-res image Download (PPT) Both cerebral aspergillosis (Brouwer et al., 2014Brouwer M.C. Tunkel A.R. McKhann G.M. van de Beek II, D. Brain abscess.N Engl J Med. 2014; 371: 447-456Crossref PubMed Scopus (225) Google Scholar) and IVRBA (Lee et al., 2007Lee T.H. Chang W.N. Su T.M. Chang H.W. Lui C.C. Ho J.T. et al.Clinical features and predictive factors of intraventricular rupture in patients who have bacterial brain abscesses.J Neurol Neurosurg Psychiatry. 2007; 78: 303-309Crossref PubMed Scopus (41) Google Scholar) are devastating conditions. Surgical intervention for Aspergillus brain abscess has been reported to reduce the mortality rate from 64% to 39% (Chen et al., 2011Chen S. Pu J.L. Yu J. Zhang J.M. Multiple Aspergillus cerebellar abscesses in a middle-aged female: case report and literature review.Int J Med Sci. 2011; 8: 635-639Crossref PubMed Scopus (18) Google Scholar). When surgery is not possible, the promising activity of voriconazole for brain aspergillosis (Schwartz et al., 2005Schwartz S. Ruhnke M. Ribaud P. Corey L. Driscoll T. Cornely O.A. et al.Improved outcome in central nervous system aspergillosis, using voriconazole treatment.Blood. 2005; 106: 2641-2645Crossref PubMed Scopus (316) Google Scholar) may allow longer patient survival than expected." @default.
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• W3092016145 date "2020-12-01" @default.
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• W3092016145 title "Intraventricular rupture of Aspergillus brain abscess during remission induction" @default.
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• W3092016145 doi "https://doi.org/10.1016/j.ijid.2020.10.010" @default.
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