Cerebral aspergillosis in the critically ill: two cases of successful medical treatment

Objective: Invasive asper- gillosis is associated with a poor prognosis, especially in critically ill patients with cerebral involvement. We present two cases of cerebral in- vasive aspergillosis successfully treated in the intensive care unit with combination antifungal therapies and without surgery. Case presentation: The first patient was a 49-year-old man with rheumatoid arthritis who received corticosteroid and cyclo- phosphamide treatment and devel- oped pulmonary and cerebral inva- sive aspergillosis. After failure of voriconazole the patient had a suc- cessful outcome with voriconazole and liposomal amphotericin B thera- py. The patient returned home after an 8-month hospital stay. The second patient was a 54-year-old woman with pulmonary neoplasia and corti- costeroid treatment who developed pulmonary and cerebral invasive as- pergillosis. After failure of voricona- zole and liposomal amphotericin B therapy the patient had a favorable outcome with liposomal amphoteri- cin B and caspofungin therapy. The patient died 10 months after initial diagnosis of cardiac tamponade un- related to fungal infection. Discus- sions: These cases illustrate the im- proving prognosis of invasive asper- gillosis due to the availability of new treatments, especially in cases of ce- rebral involvement. It also demon- strates that the outcome of critically ill patients requiring mechanical ventilation for invasive aspergillosis can be favorable. The treatment of patients with invasive cerebral as- pergillosis in the intensive care set- ting should be encouraged.