신이식 환자에서 발생한 뇌 Aspergillosis 에서 Liposomal Amphotericin B 와 내시경적 수술을 이용한 성공적인 치료

• Published in: Kidney research and clinical practice Vol. 20; no. 4; pp. 702 - 706
• Main Authors: 우영식, Young Sik Woo, 김미정, Mi Jung Kim, 장재혁, Jae Heuk Jang, 황수은, Soo Eun Hwang, 정지성, Ji Sung Chung, 신미정, Mi Jung Sin, 양철우, Chul Woo Yang, 김용수, Yong Soo Kim, 방병기, Byung Kee Bang, 박주현, Joo Hyun Park
• Format: Journal Article
• Language: Korean
• Published: 대한신장학회 30.07.2001
• Subjects: Aspergillosis; Liposomal ambisome B; Minimal invasive surgery; Renal transplant recipient; 내과학
• ISSN: 2211-9132; 2211-9140

Aspergillosis involving central nervous system is a rare but life-threatening complication in renal transplant recipients. Its mortality rate approaches almost 100% in spite of various therapeutic regimens. We here report a case of successful treatment of brain aspergillosis with liposomal amphotericin B and endoscopic surgery. A 58-year- old renal transplant recipient admitted due to headache which was developed 5 months ago. He received renal transplant 10 years ago. After admission, brain MRI revealed brain abscess on frontal lobe and this was treated with antibiotics and amphotericin B. On 20 th hospital day, endoscopic surgery via intranasal approach was performed and pathologic finding was consistent with aspergillosis. During treatment, his graft function was progressively deteriorated(serum creatinine level 2.27 mg/dL4.1 mg/dL) and amphoterinc B was replaced with ambisome. Thereafter, renal function was improved(serum creatinine 2.0 mg/dL on 46 th hospital day). Second operation was performed on 50 th hospital day to remove remnant pathologic lesion, and ambisome was continously adminstered. The brain MRI which was performed on 70 th hospital day showed much improvement. He was discharged with oral antifungal drug(itraconazole). Our case demonstrates the successful treatment of brain aspergillosis with medial treatment and minimal invasive surgery.