1991 Volume 31 Issue 13 Pages 986-990
A 15-year-old female was hospitalized for the treatment of systemic lupus erythematosus complicated with nephritis. She improved with administration of steroid hormones and an immunosuppressant, plasma exchange, and dialysis. However, a lung abscess developed 6 months after admission, and multiple brain abscesses appeared 2 months after the onset of the lung abscess. The lung abscess faded with oral administration of fluocytosine and intravenous administration of miconazole, but the brain abscesses enlarged. Intrathecal administration of miconazole was not effective. Therefore, the abscess in the right frontal lobe was surgically removed and an Ommaya's reservoir was placed in the anterior horn of the right lateral ventricle. Aspergillus was identified in the removed abscess. Subsequently, miconazole was administered intraventricularly through the Ommaya's reservoir 10 mg daily for 1 month. The abscesses in the left parietal lobe gradually diminished. One year later, she complained of right hypesthesia again. Computed tomography scan revealed enlargement of the abscess. Miconazole was administered intravenously and intraventricularly for 1 month. Second craniotomy was performed 16 months after the first surgery and the abscess was completely removed. She was discharged with mild hypesthesia of the right leg. It is concluded that intraventricular administration of miconazole through an Ommaya's reservoir is an effective therapy for central nervous system aspergillosis.
