micafungin and Neuroaspergillosis

Topics: Adult; Alkaline Phosphatase; Antifungal Agents; Arthritis; Aspergillus fumigatus; Biomarkers; Bone Remodeling; Drug Substitution; Humans; Male; Micafungin; Neuroaspergillosis; Periostitis; Risk Factors; Treatment Outcome; Up-Regulation; Voriconazole

Common variable immunodeficiency (CVID) is the most common primary immune defect, resulting in hypogammaglobulinemia as well as deficits in cell-mediated immunity. Although it mainly manifests in immunodeficiency and related infection, CVID can also be associated with autoimmune phenomena such as immune thrombocytopenic purpura, hemolytic anemia, rheumatoid arthritis, lupus, primary biliary cirrhosis, and autoimmune hepatitis (AIH). AIH is a less common but serious complication of CVID, which can result in early cirrhosis, ascites, and even hepatocellular carcinoma. Here, we discuss a recent case of transplantation for cirrhosis secondary to AIH in the context of CVID. Although the patient's surgery occurred without complication, he rapidly developed fulminant alveolar hemorrhage and seizures, and died secondary to disseminated neuroaspergillosis.

Topics: Adolescent; Aspergillus fumigatus; Common Variable Immunodeficiency; Echinocandins; Fatal Outcome; Hepatitis, Autoimmune; Humans; Lipopeptides; Liver Cirrhosis; Liver Transplantation; Male; Micafungin; Neuroaspergillosis; Radiography; Voriconazole

Invasive aspergillosis has an extremely high mortality rate. In Japan, micafungin, an echinocandin drug that has a new mechanism of action as an antifungal agent and has a clinical effect against Aspergillus species, became available in 2002. However, little is known about its penetration into the central nervous system (CNS), or its efficacy for the treatment of invasive CNS aspergillosis. We report a 65-y-old female with diabetes mellitus and CNS aspergillosis who was treated with micafungin. During treatment, micafungin concentrations were measured in the cerebrospinal fluid and plasma. On a dose of 300 mg/d, the ratio of the micafungin concentration in the cerebrospinal fluid to that in plasma was extremely low (0.2%-0.05%); nevertheless, the patient did not have a relapse of invasive CNS aspergillosis after micafungin treatment.

Topics: Aged; Amphotericin B; Antifungal Agents; Echinocandins; Female; Humans; Lipopeptides; Lipoproteins; Micafungin; Neuroaspergillosis; Peptides, Cyclic; Recurrence