11 / 11
Page 39
Notes:
Journal of Neurology and Clinical Neuroscience | Volume: 03
8
th
International Conference on
NEUROLOGICAL DISORDERS,
CENTRAL NERVOUS SYSTEM AND STROKE
&
International Conference on
NEUROLOGY AND NEUROSURGERY
December 04-05, Dubai, UAE
Joint event on
J Neurol Clin Neurosci, Volume: 03
Acute Myeloid Leukemia with Central Nervous System extension and subdural
seeding of Vancomycin-resistant
Enterococcus faecium
after bilateral subdural
Hematomas treated with subdural Daptomycin administration
Nicholas Dietz
Georgetown University School of Medicine, USA
W
e present a rare case of comorbid relapsed acute
myeloid leukemia (AML) with involvement of the
central nervous system (CNS) and subdural seeding of
vancomycin-resistant-Enterococcus faecium (VRE). The
safety profile, treatment approach with pharmacokinetic
considerations, and evaluation of success for bilateral
subdural administration of daptomycin after subdural
hematoma is assessed. A 45-year-old male with history of
AML who underwent chemotherapy (induction with 7+3)
was admitted to oncology with relapsed AML confirmed
by bone marrow biopsy, complicated by neutropenic fever
and VRE bacteremia. After acute neurological changes with
image confirmation of mixed-density bilateral subdural
hematomas secondary to thrombocytopenia, the patient
was admitted to the neurosurgery unit and underwent
bilateral burr-hole craniotomies for subdural evacuation
with placement of left and right subdural drains. Culture
of the subdural specimen confirmed VRE seeding of the
subdural space. The patient received the first dose of
daptomycin into the bilateral subdural spaces two days
after evacuation andwas noted to have acute improvement
on neurological exam, followed by a second administration
to the left subdural space 5 days after evacuation with
bilateral drains pulled thereafter. In this patient, the
complication of relapsed AML may have contributed to
the rare extension of VRE into the CNS space. Screening
for patients at risk of AML with CNS involvement and
addressing coagulopathy and risk of infection may help
mitigate morbidity. Bilateral administration of subdural
daptomycin bolused into the subdural space was tolerated
and possibly contributed to the patient’s neurological
improvement during an extended hospital course.
e:
nkd25@georgetown