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Journal of Clinical Microbiology, December 2004, p. 5950-5953, Vol. 42, No. 12
0095-1137/04/$08.00+0     DOI: 10.1128/JCM.42.12.5950-5953.2004
Copyright © 2004, American Society for Microbiology. All Rights Reserved.

CASE REPORT

Refractory Candidal Meningitis in an Immunocompromised Patient Cured by Caspofungin

Kung-Hung Liu,1 Chi-Jung Wu,1 Chen-Hsi Chou,2 Hsin-Chun Lee,1,3 Nan-Yao Lee,1 Shao-Tsung Hung,1 and Wen-Chien Ko1,3*

Department of Internal Medicine, National Cheng Kung University Hospital,1 Department of Medicine,3 Institute of Clinical Pharmacy, Medical College, National Cheng Kung University, Tainan, Taiwan2

Received 22 April 2004/ Returned for modification 2 June 2004/ Accepted 30 June 2004

Candidal meningitis is a rare infectious disease that usually leads to substantial morbidity and mortality. We present a case of candidal meningitis refractory to systemic antifungal therapy (amphotericin B and fluconazole). A 63-year-old female with lymphoblastic lymphoma and myelodysplasia with leukemia transformation developed prolonged fever and headache on the seventh day following intrathecal prophylactic chemotherapy. A lumbar puncture showed neutrophilic pleocytosis, and a cerebrospinal fluid culture yielded Candida albicans. The clinical course was complicated by brain edema, subarachnoid hemorrhage, and hydrocephalus. Parenteral therapy with amphotericin B alone or amphotericin B in combination with fluconazole or intrathecal administration of amphotericin B failed to eradicate C. albicans in the cerebrospinal fluid. After 7 days of caspofungin therapy, however, the cerebrospinal fluid became sterile and the patient gradually regained consciousness. She was discharged 1 month after completing 4 weeks of caspofungin therapy. There were two critical issues we thought to be relevant to the favorable outcome of this case. First, isolation of C. albicans was achieved by inoculating enriched liquid medium with cerebrospinal fluid. Second, there is a potential therapeutic benefit of caspofungin in treating a fungal infection of the central nervous system.

* Corresponding author. Mailing address: Department of Internal Medicine, National Cheng Kung University Hospital, No. 138, Sheng Li Rd., 704 Tainan, Taiwan. Phone: 886-6-2353535, ext. 5388. Fax: 886-6-2752038. E-mail: winston{at}mail.ncku.edu.tw.

Journal of Clinical Microbiology, December 2004, p. 5950-5953, Vol. 42, No. 12
0095-1137/04/$08.00+0     DOI: 10.1128/JCM.42.12.5950-5953.2004
Copyright © 2004, American Society for Microbiology. All Rights Reserved.



This article has been cited by other articles:

  • Pfaller, M. A., Diekema, D. J. (2007). Epidemiology of Invasive Candidiasis: a Persistent Public Health Problem. Clin. Microbiol. Rev. 20: 133-163 [Abstract] [Full Text]  
  • Pfaller, M. A., Boyken, L., Hollis, R. J., Messer, S. A., Tendolkar, S., Diekema, D. J. (2006). In Vitro Susceptibilities of Candida spp. to Caspofungin: Four Years of Global Surveillance.. J. Clin. Microbiol. 44: 760-763 [Abstract] [Full Text]  


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