Recurrent central nervous system blastomycosis in an immunocompetent child treated successfully with sequential liposomal amphotericin B and voriconazole

Division of Pediatric Hematology/Oncology, Children's National Medical Center, Washington, DC, USA.
The Pediatric Infectious Disease Journal (Impact Factor: 2.72). 05/2006; 25(4):377-9. DOI: 10.1097/01.inf.0000207475.89745.51
Source: PubMed


Central nervous system involvement in infection with Blastomyces dermatitidis is uncommon, except in immunocompromised patients. We report a case of central nervous system blastomycosis occurring 18 months after treatment of pulmonary blastomycosis in an immunocompetent child. Our patient was successfully treated sequentially with liposomal amphotericin B followed by oral voriconazole without need for surgical resection.

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    • "In immunocompromised patients and rapidly progressive lesions the fungi proliferate in great numbers forming " yeast lakes " with only minimal inflammatory response. Amphotericin B, alone or sometimes in combination with other antifungal agents (Panicker et al., 2006; Borgia et al., 2006), is the drug of choice for severe life-threatening disease. Voriconazole was reported to be successful in treatment of cerebral blastomycosis as well (Bakleh et al., 2005; Borgia et al., 2006). "
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