Successful treatment of Aspergillus ventriculitis through voriconazole adaptive pharmacotherapy, immunomodulation, and therapeutic monitoring of cerebrospinal fluid (1→3)-β-D-glucan.

Tempe K Chen, Paula K Groncy, Ramin Javahery, Richard Y Chai, Pablito Nagpala, Malcolm Finkelman, Ruta Petraitiene, Thomas J Walsh

Journal: Medical mycology 2017;55(1):109-117

PMID: 27838641

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Abstract

Aspergillus ventriculitis is an uncommon but often fatal form of invasive aspergillosis of the central nervous system (CNS). As little is known about the diagnosis, treatment, and outcome of this potentially lethal infection, we report the strategies used to successfully treat Aspergillus ventriculitis complicating a pineal and pituitary germinoma with emphasis on the critical role of adaptive pharmacotherapy of voriconazole and serial monitoring of (1→3)-β-D-glucan in cerebrospinal fluid. We describe several rationally based therapeutic modalities, including adaptive pharmacotherapy, combination therapy, sargramostim-based immunomodulation, and biomarker-based therapeutic monitoring of the CNS compartment. Through these strategies, our patient remains in remission from both his germinoma and Aspergillus ventriculitis making him one of the few survivors of Aspergillus ventriculitis.

Address: Pediatric Infectious Diseases, Department of Pediatrics, Miller Children's and Women's Hospital, Long Beach, CA, USA.; University of California, Irvine, Irvine, CA, USA.; Hematology-Oncology, Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.; Neurosurgery, Long Beach Memorial Medical Center, Miller Children's and Women's Hospital, Long Beach, CA, USA.; Radiology, Long Beach Memorial Medical Center, Miller Children's and Women's Hospital, Long Beach, CA, USA.; Endocrinology, Department of Pediatrics, Miller Children's and Women's Hospital, Long Beach, CA, USA.; Associates of Cape Cod, Inc., East Falmouth, MA, USA.; Transplantation-Oncology Infectious Diseases Program and Infectious Diseases Translational Research Laboratory, Division of Infectious Diseases, Weill Cornell Medicine, New York, NY, USA.; Transplantation-Oncology Infectious Diseases Program and Infectious Diseases Translational Research Laboratory, Division of Infectious Diseases, Weill Cornell Medicine, New York, NY, USA [email protected].; Departments of Pediatrics, and Microbiology & Immunology, Weill Cornell Medicine, New York, NY, USA.

DOI: 10.1093/mmy/myw118

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MeSH Terms: Antifungal Agents, Aspergillosis, Cerebral Ventriculitis, Cerebrospinal Fluid, Drug Monitoring, Germinoma, Humans, Immunologic Factors, Pituitary Neoplasms, Proteoglycans, Treatment Outcome, Voriconazole, beta-Glucans