Multiple Scedosporium apiospermum brain abscesses after near-drowning successfully treated with surgery and long-term voriconazole: a case report.

Scedosporium apiospermum is an emerging fungal pathogen, increasingly recognised as a cause of infection not only in immunocompromised, but also in non-immunodeficient patients. We present the case of an immunocompetent 21-year-old Thai man who experienced recurrent ruptured mycotic aneurysms and developed multiple S. apiospermum brain abscesses following aspiration of polluted water. A combination of surgery and voriconazole was effective in this difficult-to-treat case. Voriconazole penetrated the central nervous system (CNS) well and had limited toxicity, despite prolonged treatment. Voriconazole appears to be the antifungal agent of choice in the treatment of CNS scedosporiosis caused by S. apiospermum.