Treatment of Cerebral Aspergillosis with Itraconazole: Do High Doses Improve the Prognosis?

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Abstract
We describe a 72-year-old woman with chronic asthma who presented with cerebral abscesses due to Aspergillus jumigatus after she received treatment with corticosteroids. Therapy with highdose itraconazole (800 mgld for 5 months, followed by 400 mg/d for an additional 4.5 months) resulted in complete resolution of all lesions. Serum concentrations of the drug ranged from 2 µmL to 30 µ/mL. Review of 20 cases of cerebral aspergillosis that were treated with itraconazole revealed that three of the four patients who received high doses (800 mg/d in the adults) of the drug responded favorably, while only two of the 16 patients who received a dose of 400 mg/d were cured. The use of high-dose itraconazole appears to be justified for high-risk patients with cerebral aspergillosis for whom conventional therapy has failed.

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