Branko Skovrlj1, Maryam Haghighi2, Mark E Smethurst3, John Caridi4, Joshua B Bederson4. 1. Department of Neurosurgery, Mount Sinai School of Medicine, New York City, New York, USA. Electronic address: skovrlj.branko@gmail.com. 2. School of Medicine, Karolinska Institutet, Hagalund, Sweden. 3. Department of Pathology, James J. Peters VA Medical Center, Bronx, New York, USA. 4. Department of Neurosurgery, Mount Sinai School of Medicine, New York City, New York, USA.
Abstract
OBJECTIVE: To present a unique case of a brainstem Curvularia fungal infection and review the diagnosis and management of this rare phenomenon. METHODS: A 33-year-old immunocompetent African American male presented with 2 weeks of headache, nausea, and vomiting in a setting of a recent 20-lb weight loss. Neurological examination was positive for multiple cranial nerve palsies, hemisensory loss, and gait instability. Magnetic resonance imaging demonstrated an enhancing medullary lesion. RESULTS: Metastatic and infectious workup revealed a left lung lesion, which on subsequent biopsy was positive for a granuloma yielding no further clues to the etiology of the brainstem lesion. On surgical exploration of the cranial lesion, a puss-filed, encapsulated lesion was encountered that was tightly adherent to the brainstem. Intraoperative biopsy of the lesion capsule was initially negative but on postoperative day 9, fungal hyphae were encountered identified on morphology as Curvularia species. The patient was started on triple antifungal therapy but necessitated a second surgery for lesion debulking and drainage. The patient was discharged home 10 weeks after initial presentation. At the 13-months follow-up the patient is doing very well and his neurological examination continues to improve. CONCLUSIONS: This is the first reported case of a brainstem Curvularia infection. This case highlights the importance of an aggressive surgical and antibiotic therapy in the treatment of central nervous system Curvularia infections. There appears to be a strong relationship between heavy marijuana use and Curvularia infection, producing lung granulomas that may extend to other organs such as the central nervous system of immunocompetent patients.
OBJECTIVE: To present a unique case of a brainstem Curvularia fungal infection and review the diagnosis and management of this rare phenomenon. METHODS: A 33-year-old immunocompetent African American male presented with 2 weeks of headache, nausea, and vomiting in a setting of a recent 20-lb weight loss. Neurological examination was positive for multiple cranial nerve palsies, hemisensory loss, and gait instability. Magnetic resonance imaging demonstrated an enhancing medullary lesion. RESULTS: Metastatic and infectious workup revealed a left lung lesion, which on subsequent biopsy was positive for a granuloma yielding no further clues to the etiology of the brainstem lesion. On surgical exploration of the cranial lesion, a puss-filed, encapsulated lesion was encountered that was tightly adherent to the brainstem. Intraoperative biopsy of the lesion capsule was initially negative but on postoperative day 9, fungal hyphae were encountered identified on morphology as Curvularia species. The patient was started on triple antifungal therapy but necessitated a second surgery for lesion debulking and drainage. The patient was discharged home 10 weeks after initial presentation. At the 13-months follow-up the patient is doing very well and his neurological examination continues to improve. CONCLUSIONS: This is the first reported case of a brainstem Curvularia infection. This case highlights the importance of an aggressive surgical and antibiotic therapy in the treatment of central nervous system Curvularia infections. There appears to be a strong relationship between heavy marijuana use and Curvularia infection, producing lung granulomas that may extend to other organs such as the central nervous system of immunocompetent patients.
Authors: Eszter Judit Tóth; Éva Boros; Alexandra Hoffmann; Csilla Szebenyi; Mónika Homa; Gábor Nagy; Csaba Vágvölgyi; István Nagy; Tamás Papp Journal: Front Immunol Date: 2017-10-18 Impact factor: 7.561
Authors: Shanti Narayanasamy; Adam R Williams; Wiley A Schell; Rebekah W Moehring; Barbara D Alexander; Thuy Le; Ramesh A Bharadwaj; Michelle McGauvran; Jacob N Schroder; John R Perfect Journal: Open Forum Infect Dis Date: 2021-11-03 Impact factor: 3.835