1
|
Zielke T, Kim M, Simon JE, Borys E, Prabhu VC, Pappu S. Hypertrophic cranial pachymeningitis and orbital apex syndrome secondary to infection of the eye: illustrative case. Journal of Neurosurgery: Case Lessons 2021; 1:CASE20168. [PMID: 35854865 PMCID: PMC9245743 DOI: 10.3171/case20168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 12/30/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND Hypertrophic cranial pachymeningitis is a rare inflammatory disorder characterized by thickening of the dura mater and multiple cranial neuropathies. Although an infectious etiology may be present, often no specific cause is discovered. OBSERVATIONS The authors described a 71-year-old man with progressive right eye vision loss, ptosis, and complete ophthalmoplegia with imaging findings suggestive of hypertrophic cranial pachymeningitis. Extensive studies, including cerebrospinal fluid studies, showed negative results. Blood serum, cell-free evaluation, and paraffin-embedded dural tissue testing had positive results for Pseudomonas aeruginosa, which allowed treatment tailored to the organism and a salutary clinical outcome. LESSONS The constellation of neurological and radiological findings may make a diagnosis difficult in an inflammatory setting. The most precise methodology for establishing a diagnosis involves sampling the dura and testing it for infectious pathology. However, if results are inconclusive, further cell-free serum sampling with next-generation sequencing is a viable option for identifying pathogens with infectious concerns. This case highlighted the importance of multimodality studies for identifying a targetable pathogen.
Collapse
Affiliation(s)
- Tara Zielke
- Pathology, Loyola University Medical Center, Maywood, Illinois
| | - Miri Kim
- Departments of Neurological Surgery and
| | | | - Ewa Borys
- Loyola Stritch School of Medicine, Maywood, Illinois; and
| | | | - Suguna Pappu
- Departments of Neurological Surgery and
- Department of Neurological Surgery, Edward J. Hines VA Hospital, Hines, Illinois
| |
Collapse
|
2
|
|
3
|
Tang R, Li F, Chen Q. A case report of atypical long segmental thoracic hypertrophic pachymeningitis with ossification of ligamentum flavum and literature review. Eur Spine J 2017; 26:202-206. [PMID: 28365857 DOI: 10.1007/s00586-017-5030-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2016] [Accepted: 03/02/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Thoracic spinal stenosis caused by ossification of ligamentum flavum (OLF) is frequently seen, but long segmental thoracic spinal cord compressed by consequent thickened ligament posteriorly was rarely reported. OBJECT To report a case of thoracic spinal cord compression caused by atypical long segmental thoracic hypertrophic pachymeningitis (HP) with OLF. METHODS A 55-year-old woman presenting with weakness and numbness in lower extremities was admitted to our department. Combined with physical examination and MRI results, diagnosis of HP with OLF was considered. Due to progressive neurological symptoms, thoracic decompression with internal fixation was performed. RESULTS The patient felt a reduced numbness and improvement in motor functions 5 days after surgery. Pathological examination suggested the diagnosis of HP with OLF. CONCLUSIONS HP is a rare condition characterized as thickening and enhancement of the dura mater on contrast-enhanced MRI and chronic inflammatory hyperplasia changes on biopsy. A case of atypical HP complicated with OLF is described. Chondrocytes infiltration in histological examination indicates the potential of ossification in HP.
Collapse
Affiliation(s)
- Ruofu Tang
- Department of Orthopedics, The Second Affiliated Hospital, Zhejiang University School of Medicine, Jiefang Street N88, Hangzhou, Zhejiang, China.
| | - Fangcai Li
- Department of Orthopedics, The Second Affiliated Hospital, Zhejiang University School of Medicine, Jiefang Street N88, Hangzhou, Zhejiang, China
| | - Qixin Chen
- Department of Orthopedics, The Second Affiliated Hospital, Zhejiang University School of Medicine, Jiefang Street N88, Hangzhou, Zhejiang, China
| |
Collapse
|
4
|
Jee TK, Lee SH, Kim ES, Eoh W. Idiopathic hypertrophic spinal pachymeningitis with an osteolytic lesion. J Korean Neurosurg Soc 2014; 56:162-5. [PMID: 25328657 PMCID: PMC4200367 DOI: 10.3340/jkns.2014.56.2.162] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Revised: 06/29/2014] [Accepted: 08/16/2014] [Indexed: 11/27/2022] Open
Abstract
Idiopathic hypertrophic spinal pachymeningitis (IHSP) is a chronic, progressive, inflammatory disorder characterized by marked fibrosis of the spinal dura mater with unknown etiology. According to the location of the lesion, it might induce neurologic deficits by compression of spinal cord and nerve root. A 58-year old female with a 3-year history of progressive weakness in both lower extremities was referred to our institute. Spinal computed tomography (CT) scan showed an osteolytic lesion involving base of the C6 spinous process with adjacent epidural mass. Magnetic resonance imaging (MRI) revealed an epidural mass involving dorsal aspect of cervical spinal canal from C5 to C7 level, with low signal intensity on T1 and T2 weighted images and non-enhancement on T1 weighted-enhanced images. We decided to undertake surgical exploration. At the operation field, there was yellow colored, thickened fibrous tissue over the dura mater. The lesion was removed totally, and decompression of spinal cord was achieved. Symptoms improved partially after the operation. Histopathologically, fibrotic pachymeninges with scanty inflammatory cells was revealed, which was compatible with diagnosis of idiopathic hypertrophic pachymeningitis. Six months after operation, motor power grade of both lower extremities was normal on physical examination. However, the patient still complained of mild weakness in the right lower extremity. Although the nature of IHSP is generally indolent, decompressive surgery should be considered for the patient with definite or progressive neurologic symptoms in order to prevent further deterioration. In addition, IHSP can present as an osteolytic lesion. Differential diagnosis with neoplastic disease, including giant cell tumor, is important.
Collapse
Affiliation(s)
- Tae Keun Jee
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sun-Ho Lee
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Eun-Sang Kim
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Whan Eoh
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| |
Collapse
|
5
|
|
6
|
Cortez KJ, Roilides E, Quiroz-Telles F, Meletiadis J, Antachopoulos C, Knudsen T, Buchanan W, Milanovich J, Sutton DA, Fothergill A, Rinaldi MG, Shea YR, Zaoutis T, Kottilil S, Walsh TJ. Infections caused by Scedosporium spp. Clin Microbiol Rev 2008; 21:157-97. [PMID: 18202441 DOI: 10.1128/CMR.00039-07] [Citation(s) in RCA: 499] [Impact Index Per Article: 31.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Scedosporium spp. are increasingly recognized as causes of resistant life-threatening infections in immunocompromised patients. Scedosporium spp. also cause a wide spectrum of conditions, including mycetoma, saprobic involvement and colonization of the airways, sinopulmonary infections, extrapulmonary localized infections, and disseminated infections. Invasive scedosporium infections are also associated with central nervous infection following near-drowning accidents. The most common sites of infection are the lungs, sinuses, bones, joints, eyes, and brain. Scedosporium apiospermum and Scedosporium prolificans are the two principal medically important species of this genus. Pseudallescheria boydii, the teleomorph of S. apiospermum, is recognized by the presence of cleistothecia. Recent advances in molecular taxonomy have advanced the understanding of the genus Scedosporium and have demonstrated a wider range of species than heretofore recognized. Studies of the pathogenesis of and immune response to Scedosporium spp. underscore the importance of innate host defenses in protection against these organisms. Microbiological diagnosis of Scedosporium spp. currently depends upon culture and morphological characterization. Molecular tools for clinical microbiological detection of Scedosporium spp. are currently investigational. Infections caused by S. apiospermum and P. boydii in patients and animals may respond to antifungal triazoles. By comparison, infections caused by S. prolificans seldom respond to medical therapy alone. Surgery and reversal of immunosuppression may be the only effective therapeutic options for infections caused by S. prolificans.
Collapse
|
7
|
Abstract
Fungal sinusitis secondary to Pseudallescheria boydii is rare, as only 25 cases have been previously reported in the literature. Although P boydii resembles Aspergillus on pathologic examination, it is typically resistant to amphotericin B. Therefore, culture is necessary to differentiate the two. Patients with P boydii sinusitis should generally be treated with a combination of surgery and antifungal therapy. Combination treatment is particularly important for immunocompromised patients with fungal invasion because mortality among these patients is high. The prognosis is better for immunocompetent patients, even those with fungal invasion. We describe a new case of invasive fungal sinusitis secondary to P boydii infection, and we review the literature on this emerging pathogen.
Collapse
Affiliation(s)
- Dwight D. Bates
- Department of Otolaryngology, Wake Forest University School of Medicine, Winston-Salem, N.C
| | - J. Whitman Minis
- Department of Otolaryngology, Wake Forest University School of Medicine, Winston-Salem, N.C
| |
Collapse
|
8
|
Guarro J, Kantarcioglu AS, Horré R, Rodriguez-Tudela JL, Cuenca Estrella M, Berenguer J, de Hoog GS. Scedosporium apiospermum: changing clinical spectrum of a therapy-refractory opportunist*. Med Mycol 2006; 44:295-327. [PMID: 16772225 DOI: 10.1080/13693780600752507] [Citation(s) in RCA: 225] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Current knowledge on the opportunist Scedosporium apiospermum (teleomorph: Pseudallescheria boydii), generated over a period of more than 120 years, is reviewed. The natural environmental habitat of the fungus is unknown; nutrient-rich, brackish waters like river estuaria have been suggested. The fungus is strongly promoted by agricultural and particularly by industrial pollution.
Collapse
Affiliation(s)
- Josep Guarro
- Unitat de Microbiologia, Facultat de Medicina i Ciències de la Salut, Universitat Rovira i Virgili, Spain
| | | | | | | | | | | | | |
Collapse
|
9
|
Kowacs PA, Soares Silvado CE, Monteiro de Almeida S, Ramos M, Abrão K, Madaloso LE, Pinheiro RL, Werneck LC. Infection of the CNS by Scedosporium apiospermum after near drowning. Report of a fatal case and analysis of its confounding factors. J Clin Pathol 2004; 57:205-7. [PMID: 14747453 PMCID: PMC1770198 DOI: 10.1136/jcp.2003.8680] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
This report describes a fatal case of central nervous system pseudallescheriasis. A 32 year old white man presented with headache and meningismus 15 days after nearly drowning in a swine sewage reservoir. Computerised tomography and magnetic resonance imaging of the head revealed multiple brain granulomata, which vanished when steroid and broad spectrum antimicrobial and antifungal agents, in addition to dexamethasone, were started. Cerebrospinal fluid analysis disclosed a neutrophilic meningitis. Treatment with antibiotics and amphotericin B, together with fluconazole and later itraconazole, was ineffective. Miconazole was added through an Ommaya reservoir, but was insufficient to halt the infection. Pseudallescheria boydii was finally isolated and identified in cerebrospinal fluid cultures, a few days before death, three and a half months after the symptoms began. Diagnosis was delayed because of a reduction in the lesions after partial treatment, which prevented a stereotactic biopsy. Physicians should be aware of this condition, and provide prompt stereotactic biopsy. Confirmed cases should perhaps be treated with voriconazole, probably the most effective, currently available treatment for this agent.
Collapse
Affiliation(s)
- P A Kowacs
- Division of Neurology, Internal Medicine Department, Hospital de Clínicas da Universidade Federal do Paraná, 80060-900 Curitiba, Brazil.
| | | | | | | | | | | | | | | |
Collapse
|
10
|
Abstract
PURPOSE We report the treatment and follow-up, including MRI, of two patients with idiopathic hypertrophic pachymeningitis and review the English language literature, with emphasis on management and outcome in this rare disorder. METHODS AND MATERIALS The files of two patients were reviewed, with relevant histopathology and imaging (MRI). The first patient has been followed for sixteen years (the longest MRI-documented postoperative course reported for this condition) and the second for two years. The English language literature was reviewed, including a summary of all reported patients that have been followed with MRI or CT imaging. RESULTS Despite extensive investigation, no underlying etiology was determined in either patient. Histopathological studies revealed a chronic inflammatory dural infiltrate in both patients, with granulomas in the first but not the second patient. The first patient underwent surgery twice and has remained stable for sixteen years, despite persistent neurologic deficits. The second patient was managed with dexamethasone after a surgical biopsy, and experienced complete resolution of all neurological deficits and abnormalities seen with MRI. CONCLUSIONS Although prompt and extensive surgery has been recommended for this condition, the results from our second patient indicate that complete remission can be achieved in some patients with biopsy and steroid therapy. This also supports the view that autoimmune mechanisms underlie idiopathic hypertrophic pachymeningitis. The first patient illustrates that extensive laminectomies may be an effective therapeutic option but chronic discomfort may result. If extensive surgery must be performed, laminoplasty should be done because of the potential for reduced pain and improved long-term spinal stability.
Collapse
Affiliation(s)
- A S Dumont
- Department of Clinical Neurosciences, Faculty of Medicine, University of Calgary, Alberta, Canada
| | | | | | | |
Collapse
|
11
|
Nesky MA, McDougal EC, Peacock JE. Pseudallescheria boydii brain abscess successfully treated with voriconazole and surgical drainage: case report and literature review of central nervous system pseudallescheriasis. Clin Infect Dis 2000; 31:673-7. [PMID: 11017814 DOI: 10.1086/314042] [Citation(s) in RCA: 132] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/1999] [Revised: 01/28/2000] [Indexed: 11/03/2022] Open
Abstract
Pseudallescheria boydii and its asexual form, Scedosporium apiospermum, are ubiquitous, saprophytic fungi that commonly cause cutaneous infection. However, in certain circumstances, P. boydii can also cause invasive disease, which can involve the central nervous system (CNS). When the CNS becomes involved, treatment is difficult, therapeutic options are limited, and the prognosis is poor. We report a case of Pseudallescheria brain abscess successfully treated with surgical drainage and systemic voriconazole, the first such case to be described in the literature. We also review previously reported cases of CNS pseudallescheriasis and evaluate therapeutic options.
Collapse
Affiliation(s)
- M A Nesky
- Department of Internal Medicine, Division of Infectious Diseases, Wake Forest University School of Medicine, Winston-Salem, NC 27157-1042, USA
| | | | | |
Collapse
|
12
|
Abstract
INTRODUCTION Pachymeningitis is a fibrous inflammatory process with non-specific symptoms, involving the dura mater. Due to MRI development, diagnosis is both easier and earlier. CURRENT KNOWLEDGE AND KEY POINTS We report seven cases and review current literature. Clinical features are headaches and cranial nerve palsies. CSF shows inflammatory changes, while MRI evidences thickening of the dura mater. Disease etiologies in the present study were tuberculosis in two cases, sarcoidosis, Lyme disease, lymphoma and dural puncture; in one case only the disease was of unknown origin. The condition of six patients improved with specific treatment. FUTURE PROSPECTS AND PROJECTS Further MRI development should allow detection of new forms of pachymeningitis and standardization of patients' management through the study of more important series.
Collapse
Affiliation(s)
- O Fain
- Service de médecine interne, hôpital Jean-Verdier, Bondy, France
| | | | | | | | | | | | | | | |
Collapse
|
13
|
Abstract
OBJECTIVE AND IMPORTANCE We present a case similar to previously described cases of idiopathic hypertrophic cranial pachymeningitis. However, our patient responded to antituberculous therapy. This raises the possibility that some cases of "idiopathic" hypertrophic cranial pachymeningitis may represent occult tuberculous disease. CLINICAL PRESENTATION A 55-year-old woman presented with a right fourth nerve palsy and a 5-month history of headaches. Magnetic resonance imaging with gadolinium revealed thick enhancing dura on the right half of the tentorium cerebelli, with edema of the adjacent midbrain, pons, and cerebral peduncle. INTERVENTION Open biopsy of the tentorial lesion revealed only dense fibrosis with histiocytic infiltration. An exhaustive search failed to demonstrate an underlying cause. In particular, mycobacterial stains/cultures were negative, there was no granuloma formation, and the chest x-ray was unremarkable. However, because of a strongly positive purified protein-derivative skin test and residence in an area endemic for tuberculosis, the patient was placed on antituberculous medications. CONCLUSION The patient's symptoms and signs resolved with antituberculous therapy. Resolution of the tentorial lesion was confirmed by gadolinium-enhanced magnetic resonance imaging. We conclude that this case represented occult tuberculous disease. An empiric trial of antituberculous therapy may be warranted in other cases of apparently idiopathic hypertrophic cranial pachymeningitis.
Collapse
Affiliation(s)
- I F Parney
- Department of Surgery, University of Alberta, Edmonton, Canada
| | | | | |
Collapse
|
14
|
Wilichowski E, Christen HJ, Schiffmann H, Schulz-Schaeffer W, Behrens-Baumann W. Fatal Pseudallescheria boydii panencephalitis in a child after near-drowning. Pediatr Infect Dis J 1996; 15:365-70. [PMID: 8866809 DOI: 10.1097/00006454-199604000-00016] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- E Wilichowski
- Department of Pediatrics/Neuropediatrics, Universitäts-Kinderklinik, Göttingen, Germany
| | | | | | | | | |
Collapse
|
15
|
Abstract
A 36-year-old woman presented suffering from severe headache and diploia. Magnetic resonance imaging showed a diffuse thickening of the cranial dura mater which was enhanced by gadolinium-DTPA. Two months later, an improvement of the clinical symptoms and a spontaneous resolution of the dural thickening were noted. Hypertrophic cranial pachymeningitis and other diseases causing diffuse dural thickening are discussed.
Collapse
Affiliation(s)
- S Nishio
- Department of Neurosurgery, Faculty of Medicine, Kyushu University, Fukuoka, Japan
| | | | | | | | | | | | | |
Collapse
|
16
|
Abstract
A 55-year-old woman with a unique form of chronic hypertrophic pachymeningitis involving the posterior fossa and upper cervical spine is reported. Unlike other cases previously described, the clinical picture was dominated by signs of increased intracranial pressure, lower cranial nerve disorders, and a progressive cervical radiculomyelopathy. The diagnosis was made by means of a contrast-enhanced magnetic resonance imaging scan and confirmed by histological examination of the excised dura. Surgical treatment with removal of the hypertrophic dura provided temporary relief, although the natural history of the disease was not modified. Exhaustive bacteriological and histopathological studies failed to identify a specific cause for this diffuse hypertrophy of the cranial and cervical dura. The literature is reviewed, and other histologically documented cases are discussed.
Collapse
Affiliation(s)
- C Botella
- Department of Neurosurgery, Hospital La Fe, Valencia, Spain
| | | | | | | |
Collapse
|
17
|
Botella C, Orozco M, Navarro J, Riesgo P. Idiopathic Chronic Hypertrophic Craniocervical Pachymeningitis: Case Report. Neurosurgery 1994; 35:1144???1149. [DOI: 10.1097/00006123-199412000-00020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|
18
|
|
19
|
Abstract
Hypertrophic cranial pachymeningitis is uncommon. We report the first case of pachymeningitis extending to the cerebral parenchyma (pachymeningoencephalitis) and involving the bone and extracranial soft tissue. The clinical features and pathogenesis are discussed.
Collapse
Affiliation(s)
- C Kadoya
- Department of Neurosurgery, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | | | | | | |
Collapse
|
20
|
Abstract
A case of hypertrophic cranial pachymeningitis is described and the MR appearance presented. A gadopentetate-dimeglumine-enhanced MR scan enhanced markedly suggesting thickening and inflammation of dura and falx cerebri. The patient, a 72-year-old elderly man, had surprisingly little clinical abnormality. His only neurological manifestation was progressive unilateral blindness. The exact cause of his pachymeningitis was unknown, though neither rheumatoid arthritis nor other collagen disease was completely excluded.
Collapse
Affiliation(s)
- S Shintani
- Department of Neurology, Toride Kyodo General Hospital, Ibaraki, Japan
| | | | | |
Collapse
|
21
|
Abstract
A 59-year-old woman suffered from occipital headache and bilateral cranial nerve VII, VIII, IX, X, XI and right XII deficit after developing otitis media. Magnetic resonance imaging (MRI) showed a thickening of the dura mater which was enhanced by gadolinium-DTPA (Gd). Aspergillus flavus was identified from the culture of otorrhea. She was treated with miconazole, flucytosin and fluconazole, which resulted in an improvement of the clinical symptoms and a thinning of the Gd-enhanced lesions on MRI. This is the first case of hypertrophic cranial pachymeningitis caused by Asp. flavus infection.
Collapse
Affiliation(s)
- H Murai
- Department of Neurology, Faculty of Medicine, Kyushu University, Fukuoka, Japan
| | | | | | | | | | | |
Collapse
|
22
|
Abstract
Pseudallescheria (Petriellidium) boydii is the most frequent etiologic agent of mycetoma in temperate regions of the world. In addition, it may also occur as a systemic infection in immunocompromised patients. Infection of the central nervous system is rare, and only eleven cases of Pseudallescheria brain abscess have been documented. We report a leukemic patient in whom disseminated pseudallescheriasis was diagnosed only after death. This case is unique in that a white matter cavitation was present containing a fungoma of Pseudallescheria, the first report of a cerebral fungus ball caused by this organism. The previous cases of Pseudallescheria brain abscess are reviewed, and the histopathologic features of Pseudallescheria which permit its differentiation from Aspergillus and other fungi are discussed.
Collapse
Affiliation(s)
- D A Schwartz
- Department of Pathology, Beth Israel Hospital, Boston, MA 02215
| | | | | |
Collapse
|
23
|
Abstract
The authors present the case of a 25-year-old man with idiopathic pachymeningitis hypertrophica that caused cervical radiculopathy. Decompressive surgery produced significant neurological improvement. The etiology and management of the condition are discussed and the literature is reviewed.
Collapse
|
24
|
|
25
|
|
26
|
Abstract
The authors describe the first reported case of post-craniotomy wound infection due to Pseudallescheria boydii. The patient was a 24-year-old man who sustained a direct blunt injury to the calvaria, resulting in a large subdural hematoma that was surgically evacuated. Subsequently, the surgical wound became infected with a fungus, P. boydii, and was successfully treated with intravenous miconazole.
Collapse
|
27
|
Abstract
Pseudallescheria boydii is a recognized cause of mycetoma, a chronic fungal disease that usually affects the extremities. Isolated case reports have also implicated P. boydii in infections of other sites. We report the first large series (83 isolates) of P. boydii in 46 patients, including the second report of P. boydii brain abscess and disseminated infection in a noncompromised host. Between 1974 and 1984 at our institution, P. boydii was cultured from a variety of sites: respiratory tract, 36; soft tissue, 25; bone, 9; gastric aspirate, 4; maxillary sinus, 2; wound, 2; urine, 2; brain abscess, 1; ear, 1; and toenail, 1. Pulmonary colonization proved to be the most common form of pseudallescheriasis of the lung (34 of 36 cultures in this category); 28 of the 32 patients with pulmonary infections had received immunosuppressive therapy or had an underlying disorder. The importance of isolation of P. boydii from bone and soft tissue is supported in this series because all 9 cultures from bone and 21 of 25 cultures from soft tissue were associated with infection. Of 10 cases of infection, 5 were osteomyelitis and 2 were infected wounds; in addition, maxillary sinusitis, disseminated infection, and a lung abscess occurred in 1 patient each.
Collapse
|