POSTTRAUMATIC INTRACRANIAL EPIDURAL ASPERGILLUS-FUMIGATUS ABSCESS

We report an intracranial epidural abscess caused by Aspergillus fumig atus in an immunocompetent patient. Infection occurred in a 20-year-ol d man 2 months after a frontal craniotomy following trauma. The absces s was encapsulated by a thickened dura and although the fungus did not invade the brain, frontal bone was infected and the patient presented with a subcutaneous frontal cellulitis. Initial management combined s urgical drainage, resection of necrotic bone and liposomal amphoterici n B (1 mg kg(-1) per day). After 3 weeks of antifungal treatment a sec ond evaluation surgery was performed. A clinically and radiologically unsuspected new abscess was found and evacuated. Treatment was complet ed with instillation into the cavity of amphotericin B at a concentrat ion of 5 mg ml(-1) and prolonged oral itraconazole (400-600 mg day(-1) ). Treatment was successful and the patient is free of infection after 3 years.