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Isavuconazole Treatment of Spinal Cord Invasive Aspergillosis Guided by Cerebrospinal Fluid (1,3)-β-d-Glucan Levels in a Patient with Low Interferon-Gamma and Ulcerative Colitis.

Siobhan O'ReganBrendan O'KellyPaul ReidyAoibhlinn O'TooleJohn CairdCora McNallySamuel McConkeyEoghan De Barra
Published in: Journal of fungi (Basel, Switzerland) (2022)
This case highlights the use of (1,3)-beta-d glucan to direct treatment of a cervical spinal cord Aspergillus fumigatus infection in a 22-year-old woman immunocompromised due to steroid and anti-TNF therapy in the context of ulcerative colitis and interferon gamma deficiency. A 4-year treatment course requiring neurosurgical intervention on four occasions and prolonged antifungal therapy, including isavuconazole, resulted in clinical cure with a corresponding decrease in CSF beta-d-glucan to <30 pg/mL. Serum and CSF galactomannan levels were not elevated at any point during the clinical course.
Keyphrases
  • spinal cord
  • ulcerative colitis
  • cerebrospinal fluid
  • spinal cord injury
  • rheumatoid arthritis
  • combination therapy
  • replacement therapy
  • acute respiratory distress syndrome
  • extracorporeal membrane oxygenation