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CC BY-NC-ND 4.0 · Asian J Neurosurg 2018; 13(03): 792-796
DOI: 10.4103/ajns.AJNS_236_16
Case Report

Scedosporium apiospermum: An emerging fatal cause of fungal abscess and ventriculitis after near-drowning

Min-gi Lee
1   Department of Neurosurgery, College of Medicine, The Catholic University of Korea, Seoul St. Mary's Hospital, Seoul
,
Jin-gyu Choi
1   Department of Neurosurgery, College of Medicine, The Catholic University of Korea, Seoul St. Mary's Hospital, Seoul
,
Byung-chul Son
1   Department of Neurosurgery, College of Medicine, The Catholic University of Korea, Seoul St. Mary's Hospital, Seoul
2   Catholic Neuroscience Institute, College of Medicine, The Catholic Universtiy of Korea, Seoul
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Herein, we describe a fatal case of central nervous system (CNS) pseudallescheriasis following near-drowning. A 13-year-old boy, who had been successfully resuscitated after near-drowning, presented with a transient episode of mental confusion during a hospital stay after recovering from severe aspiration pneumonia and respiratory failure. A magnetic resonance imaging (MRI) scan of the brain showed a small brain abscess in the left basal ganglia and ventriculitis in the left lateral ventricle. The brain abscess and ventriculitis did not respond to 4 weeks of antibiotic treatment and appeared even worse on a follow-up MRI. A diagnosis of CNS pseudallescheriasis was only possible with invasive stereotactic biopsy and aspiration of the abscess that showed the presence of hyphae and Scedosporium apiospermum. CNS pseudallescheriasis did not respond to multiple combinations of antifungal agents, including amphotericin B, isoconazole, itraconazole, and voriconazole. Two ventricular drainages and insertion of Ommaya reservoirs with intraventricular injection of voriconazole were insufficient to halt the infection. The patient passed away from sudden septic shock 2 months after identification of the brain abscess and ventriculitis. The patient's diagnosis was delayed because multiple examinations of the cerebrospinal fluid did not show positive cultures and could only be obtained from the aspirates of stereotactic biopsy. Physicians should be aware of CNS pseudallescheriasis associated with near-drowning because of the difficulty of diagnosis and the high mortality rate (70%) owing to poor responses to currently available antifungal agents.

Key-words:

Brain abscess - cerebral infections - fungal meningitis - near-drowning - Pseudallescheria boydii - Scedosporium apiospermum


Publication History

Article published online:
14 September 2022

© 2018. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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