Successful treatment of invasive <i>Aspergillus</i> rhinosinusitis and orbital aspergillosis with oral isavuconazole in a patient with contraindications to conventional first- and second-line therapy
Bibliographic record
Abstract
Abstract Objectives Acute invasive fungal rhinosinusitis represents a severe, life-threatening condition that necessitates prompt diagnosis and intervention. In this case report, we discuss the use of isavuconazole, a novel, broad-spectrum triazole antifungal, approved for use in Canada in 2019 (Government of Canada. Summary Basis of Decision – Cresemba – Health Canada. Summary Basis of Decision. 2019. Accessed 6 June 2024. https://hpr-rps.hres.ca/reg-content/summary-basis-decision-detailTwo.php?linkID=SBD00424#:~:text=Summary%20Basis%20of%20Decision%20(SBD)%20for%20Cresemba&text=Summary%20Basis%20of%20Decision%20(SBD)%20documents%20provide%20information%20related%20to,original%20authorization%20of%20a%20product) that can be considered an alternative to voriconazole. Methods We present the case of a 78-year-old man with a unique case of invasive Aspergillus rhinosinusitis and orbital aspergillosis. He was admitted for urgent left maxillary antrostomy, left anterior and posterior ethmoidectomy, and left transorbital resection of lesion tissue with orbital decompression. His treatment course was complicated by a contraindication to voriconazole because of prolonged QTc interval and inability to tolerate IV amphotericin B. Key findings The patient was treated with a 14-week course of isavuconazole as an alternative to voriconazole. At 3 months, there was no clinical evidence for infection, and the patient was sent for a computed tomography (CT) of the head and sinus to assess for evidence of active infection or bone destruction, which showed significant improvement in paranasal sinus inflammation and soft tissue infiltration. At his 6-month follow-up, his CT head showed regression in inflammatory change, with no deterioration in his sinusitis, and no further antifungal treatment was required. Conclusions Given the novelty of isavuconazole, there has been limited experience with its use in the setting of rhinosinusitis and orbital invasive aspergillosis. This case highlights isavuconazole as a reasonable alternative to voriconazole and other triazoles in patients that are intolerant or have contraindications related to QTc prolongation.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.003 | 0.003 |
| Insufficient payload (model declined to judge) | 0.001 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".