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American Journal of Hospice and Palliative Medicine®
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Central nervous system aspergillosis in an immunocompetent patient: Cure in a hospice setting with very high-dose itraconazole

Akilesh Palanisamy, MD

Laguna Honda Hospice & Palliative Care Service, Laguna Honda Hospital, San Francisco, California

Stephanie D. Chao, BS

Laguna Honda Hospice & Palliative Care Service, Laguna Honda Hospital, San Francisco, California

Michelle Fouts, PharmD

Laguna Honda Hospice & Palliative Care Service, Laguna Honda Hospital, San Francisco, California

Derek Kerr, MD, CNA

Laguna Honda Hospice & Palliative Care Service, Laguna Honda Hospital, San Francisco, California

Aspergillosis of the central nervous system (CNS) is a rare condition with exceedingly high mortality. This study describes the case of an immunocompetent 42-year-old man with a history of intravenous drug use and hepatitis C who developed multiple Aspergillus lesions in the cerebellum. Despite neurosurgery and antifungal therapy with amphotericin B, he had a protracted hospital course with multiple complications, eventually developing cognitive and motor impairment due to progressive cerebellar lesions. After transfer to hospice and palliative care service, oral itraconazole was escalated to 1600 mg/day with the hope of palliating headache, nausea, and cognitive impairment. Remarkably, the patient stabilized and improved over time. After 14 months, this unprecedented high-dose regimen was discontinued, and the patient was discharged home with only mild cerebellar motor impairment.

Key Words: itraconazole • Aspergillus • hospice • central nervous system • cerebrum

American Journal of Hospice and Palliative Medicine®, Vol. 22, No. 2, 139-144 (2005)
DOI: 10.1177/104990910502200212
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This article has been cited by other articles:


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P. Leroy, A. Smismans, and T. Seute
Invasive Pulmonary and Central Nervous System Aspergillosis After Near-Drowning of a Child: Case Report and Review of the Literature
Pediatrics, August 1, 2006; 118(2): e509 - e513.
[Abstract] [Full Text] [PDF]


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