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Tue, 26 Mar 2002 22:46:12 +0500

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Dear Members,
I am an SHO at ICU in Sheikh Zayed Hospital , Lahore, Pakistan.We have an
immunocompetent, not a  known diabetic previously, 46 years old female
patient whose initial complaints were visual disturbances in her right eye,
there was unilateral papilloedma, there was no other clinical feature. CT and
MRI showed hypo dense area in the left occipital lobe with suspected diagnosis
of Meningioma. She was put on elective list but started menstrual bleeding on
the day of operation and was post poned for one week. She presented 5 days
later with history of vomiting, fall , fits and loss of consciousness. She was
operated the next day by the neurosurgeon. Operative findings were dirty
looking , abscess, in the left occipital lobe, frozen section was done and
hyphae were seen and fungal abscess was diagnosed. Clearance up to the normal
tissue could not be done due to extent.
Patient has been in the ICU for the last 20 days, she has been Rt. sided
hemiplegic, drowsy/clouded consciousness and  globally aphasic since then.
She is on
1- IV amphotericin B initially BiD but now since day 10 on BD on alternate
days.
2-itraconazole capsules BD through NG tube
3- Clafron IV
4- NG feeding

She has been afebrile all the way. Her creatinine initially went to 2.3 mg/dL
but has now dropped back to 1.3 mg/dL.
I would like to know about further management and what can be done for this
patient. Any in put or guidance would be greatly welcome.
Thank you
Dr Zubair  e-mail : aumair@go.net.pk

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<!doctype html public "-//w3c//dtd html 4.0 transitional//en">
<html>
Dear Members,
 I am an SHO at ICU in Sheikh Zayed Hospital , Lahore, Pakistan.We
have an immunocompetent, not a&nbsp; known diabetic previously, 46 years
old female&nbsp; patient whose initial complaints were visual disturbances
in her right eye, there was unilateral papilloedma, there was no other
clinical feature. CT and MRI showed hypo dense area in the left occipital
lobe with suspected diagnosis of Meningioma. She was put on elective list
but started menstrual bleeding on the day of operation and was post poned
for one week. She presented 5 days later with history of vomiting, fall
, fits and loss of consciousness. She was operated the next day by the
neurosurgeon. Operative findings were dirty looking , abscess, in the left
occipital lobe, frozen section was done and hyphae were seen and fungal
abscess was diagnosed. Clearance up to the normal tissue could not be done
due to extent.
 Patient has been in the ICU for the last 20 days, she has been Rt.
sided hemiplegic, drowsy/clouded consciousness and&nbsp; globally aphasic
since then.
 She is on
 1- IV amphotericin B initially BiD but now since day 10 on BD on
alternate days.
 2-itraconazole capsules BD through NG tube
 3- Clafron IV
 4- NG feeding
She has been afebrile all the way. Her creatinine initially went
to 2.3 mg/dL but has now dropped back to 1.3 mg/dL.
 I would like to know about further management and what can be done
for this patient. Any in put or guidance would be greatly welcome.
 Thank you
 Dr Zubair&nbsp; e-mail : aumair@go.net.pk
 &nbsp;
 &nbsp;</html>

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