1: J Med Vet Mycol. 1997 Jul-Aug;35(4):279-82.
Post-traumatic intracranial epidural Aspergillus fumigatus abscess
Letscher V, Herbrecht R, Gaudias J, Taglang G, Koenig H, Dupuis MG, Waller J.
Institut de Parasitologie et de Pathologie Tropicale, Strasbourg, France.
We report an intracranial epidural abscess caused by Aspergillus fumigatus in an immunocompetent patient. Infection occurred in a 20-year-old man 2 months after a frontal craniotomy following trauma. The abscess was encapsulated by a thickened dura and although the fungus did not invade the brain, frontal bone was infected and the patient presented with a subcutaneous frontal cellulitis. Initial management combined surgical drainage, resection of necrotic bone and liposomal amphotericin B (1 mg kg-1 per day). After 3 weeks of antifungal treatment a second evaluation surgery was performed. A clinically and radiologically unsuspected new abscess was found and evacuated. Treatment was completed with instillation into the cavity of amphotericin B at a concentration of 5 mg ml-1 and prolonged oral itraconazole (400-600 mg day-1). Treatment was successful and the patient is free of infection after 3 years.