Relapse of Fungal Meningitis Associated with Contaminated Methylprednisolone

Abstract

noabstract: letter Extract: To the Editor: Since September 2012, the Centers for Disease Control and Prevention (CDC) and state and local health departments have been investigating an outbreak of fungal infections associated with injections from three lots of contaminated methylprednisolone acetate produced at a single compounding pharmacy.1 As of May 6, 2013, a total of 741 cases have been reported in 20 states, with 55 deaths. The primary pathogen isolated from patient specimens has been Exserohilum rostratum, which has also been recovered from sealed vials of methylprednisolone acetate. Before this outbreak, human infections with E. rostratum were rarely reported.2,3 Little is known about the management of E. rostratum infections, especially when the disease involves the central nervous system. The current guidance4 suggests 3 to 6 months of antifungal therapy for parameningeal infections, with longer therapy in patients with severe disease (e.g., diskitis or osteomyelitis). For patients with meningitis, a minimum of 3 months of treatment is recommended, with up to 1 year of treatment recommended for patients with severe central nervous system involvement (e.g., stroke or arachnoiditis).