Intracranial Fusarium Fungal Abscess in an Immunocompetent Patient: Case Report and Review of the Literature

Asa Peterson; Martin H. Pham; Brian Lee; Deborah Commins; Joseph Cadden; Steven L. Giannotta; Gabriel Zada

doi:10.1055/s-0034-1387182

Journal of Neurological Surgery Reports, Table of Contents

J Neurol Surg Rep 2014; 75(02): e241-e245
DOI: 10.1055/s-0034-1387182

Case Report

Georg Thieme Verlag KG Stuttgart · New York

Intracranial Fusarium Fungal Abscess in an Immunocompetent Patient: Case Report and Review of the Literature

Authors

Asa Peterson

¹Department of Neurosurgery, Keck School of Medicine, University of Southern California, Los Angeles, California, United States
Martin H. Pham

¹Department of Neurosurgery, Keck School of Medicine, University of Southern California, Los Angeles, California, United States
Brian Lee

¹Department of Neurosurgery, Keck School of Medicine, University of Southern California, Los Angeles, California, United States
Deborah Commins

²Department of Pathology, Keck School of Medicine, University of Southern California, Los Angeles, California, United States
Joseph Cadden

³Department of Infectious Disease, Keck School of Medicine, University of Southern California, Los Angeles, California, United States
Steven L. Giannotta

¹Department of Neurosurgery, Keck School of Medicine, University of Southern California, Los Angeles, California, United States
Gabriel Zada

¹Department of Neurosurgery, Keck School of Medicine, University of Southern California, Los Angeles, California, United States

Abstract

Introduction Fusarium spp is an omnipresent fungal species that may lead to fatal infections in immunocompromised populations. Spontaneous intracranial infection by Fusarium spp in immunocompetent individuals is exceedingly rare.

Case Report An immunocompetent 33-year-old Hispanic woman presented with persistent headaches and was found to have a contrast-enhancing mass in the left petrous apex and prepontine cistern. She underwent a subsequent craniotomy for biopsy and partial resection that revealed a Fusarium abscess. She had a left transient partial oculomotor palsy following the operation that resolved over the next few weeks. She was treated with long-term intravenous antifungal therapy and remained at her neurologic baseline 18 months following the intervention.

Discussion To our knowledge, this is the first reported case of Fusarium spp brain abscess in an immunocompetent patient. Treatment options include surgical intervention and various antifungal medications.

Conclusion This case demonstrates the rare potential of intracranial Fusarium infection in the immunocompetent host, as well as its successful treatment with surgical aspiration and antifungal therapy.

Keywords

intracranial abscess - Fusarium - fungal infection

Full Text

References

References
1 Booth C. The Genus Fusarium. Kew, UK: Commonwealth Mycology Institute; 1971
2 Nelson PE, Dignani MC, Anaissie EJ. Taxonomy, biology, and clinical aspects of Fusarium species. Clin Microbiol Rev 1994; 7 (4) 479-504
3 Gupta AK, Baran R, Summerbell RC. Fusarium infections of the skin. Curr Opin Infect Dis 2000; 13 (2) 121-128
4 Dignani MC, Anaissie E. Human fusariosis. Clin Microbiol Infect 2004; 10 (Suppl. 01) 67-75
5 Walsh TJ, Groll A, Hiemenz J, Fleming R, Roilides E, Anaissie E. Infections due to emerging and uncommon medically important fungal pathogens. Clin Microbiol Infect 2004; 10 (Suppl. 01) 48-66
6 Musa MO, Al Eisa A, Halim M , et al. The spectrum of Fusarium infection in immunocompromised patients with haematological malignancies and in non-immunocompromised patients: a single institution experience over 10 years. Br J Haematol 2000; 108 (3) 544-548
7 O'Donnell K, Sutton DA, Rinaldi MG , et al. Internet-accessible DNA sequence database for identifying Fusaria from human and animal infections. J Clin Microbiol 2010; 48 (10) 3708-3718
8 Epstein AB. In the aftermath of the Fusarium keratitis outbreak: what have we learned?. Clin Ophthalmol 2007; 1 (4) 355-366
9 Pflugfelder SC, Flynn Jr HW, Zwickey TA , et al. Exogenous fungal endophthalmitis. Ophthalmology 1988; 95 (1) 19-30
10 Hwang SM, Suh MK, Ha GY. Onychomycosis due to nondermatophytic molds. Ann Dermatol 2012; 24 (2) 175-180
11 Moreno G, Arenas R. Other fungi causing onychomycosis. Clin Dermatol 2010; 28 (2) 160-163
12 Romano C, Caposciutti P, Ghilardi A, Miracco C, Fimiani M. A case of primary localized cutaneous infection due to Fusarium oxysporum . Mycopathologia 2010; 170 (1) 39-46
13 Yan X, Yu C, Shi Z, Wang S, Zhang F. Nasal cutaneous infection in a healthy boy caused by Fusarium moniliforme . Pediatr Dermatol 2013; 30 (4) e43-e45
14 Unal A, Kocyigit I, Sipahioglu MH, Tokgoz B, Oymak O, Utas C. Fungal peritonitis in peritoneal dialysis: an analysis of 21 cases. Int Urol Nephrol 2011; 43 (1) 211-213
15 Jossi M, Ambrosioni J, Macedo-Vinas M, Garbino J. Invasive fusariosis with prolonged fungemia in a patient with acute lymphoblastic leukemia: case report and review of the literature. Int J Infect Dis 2010; 14 (4) e354-e356
16 Edupuganti S, Rouphael N, Mehta A , et al. Fusarium falciforme vertebral abscess and osteomyelitis: case report and molecular classification. J Clin Microbiol 2011; 49 (6) 2350-2353
17 Sierra-Hoffman M, Paltiyevich-Gibson S, Carpenter JL, Hurley DL. Fusarium osteomyelitis: case report and review of the literature. Scand J Infect Dis 2005; 37 (3) 237-240
18 Charles JF, Eberle C, Daikh DI, Rooney T. Resolution of recurrent Fusarium arthritis after prolonged antifungal therapy. J Clin Rheumatol 2011; 17 (1) 44-45
19 Gradon JD, Lerman A, Lutwick LI. Septic arthritis due to Fusarium moniliforme . Rev Infect Dis 1990; 12 (4) 716-717
20 Jakle C, Leek JC, Olson DA, Robbins DL. Septic arthritis due to Fusarium solani . J Rheumatol 1983; 10 (1) 151-153
21 Wadhwani K, Srivastava AK. Fungi from otitis media of agricultural field workers. Mycopathologia 1984; 88 (2-3) 155-159
22 Macêdo DP, Neves RP, Fontan J, Souza-Motta CM, Lima D. A case of invasive rhinosinusitis by Fusarium verticillioides (Saccardo) Nirenberg in an apparently immunocompetent patient. Med Mycol 2008; 46 (5) 499-503
23 Park AH, Muntz HR, Smith ME, Afify Z, Pysher T, Pavia A. Pediatric invasive fungal rhinosinusitis in immunocompromised children with cancer. Otolaryngol Head Neck Surg 2005; 133 (3) 411-416
24 Gorman SR, Magiorakos A-P, Zimmerman SK, Craven DE. Fusarium oxysporum pneumonia in an immunocompetent host. South Med J 2006; 99 (6) 613-616
25 Agamanolis DP, Kalwinsky DK, Krill Jr CE, Dasu S, Halasa B, Galloway PG. Fusarium meningoencephalitis in a child with acute leukemia. Neuropediatrics 1991; 22 (2) 110-112
26 Anaissie E, Kantarjian H, Ro J , et al. The emerging role of Fusarium infections in patients with cancer. Medicine (Baltimore) 1988; 67 (2) 77-83
27 Anten S, Heddema ER, Visser O, Zweegman AS. Images in haematology. Cerebral fungal abscess in a patient with acute promyelocytic leukaemia. Br J Haematol 2008; 140 (3) 253
28 Antunes NL, Hariharan S, DeAngelis LM. Brain abscesses in children with cancer. Med Pediatr Oncol 1998; 31 (1) 19-21
29 Boutati EI, Anaissie EJ. Fusarium, a significant emerging pathogen in patients with hematologic malignancy: ten years' experience at a cancer center and implications for management. Blood 1997; 90 (3) 999-1008
30 de Medeiros BC, de Medeiros CR, Werner B , et al. Central nervous system infections following bone marrow transplantation: an autopsy report of 27 cases. J Hematother Stem Cell Res 2000; 9 (4) 535-540
31 Kleinschmidt-Demasters BK. Disseminated Fusarium infection with brain abscesses in a lung transplant recipient. Clin Neuropathol 2009; 28 (6) 417-421
32 Njambi S, Huttova M, Kovac M, Freybergh PF, Bauer F, Muli JM. Fungal neuroinfections: rare disease but unacceptably high mortality. Neuroendocrinol Lett 2007; 28 (Suppl. 02) 25-26
33 Pagano L, Caira M, Falcucci P, Fianchi L. Fungal CNS infections in patients with hematologic malignancy. Expert Rev Anti Infect Ther 2005; 3 (5) 775-785
34 Steinberg GK, Britt RH, Enzmann DR, Finlay JL, Arvin AM. Fusarium brain abscess. Case report. J Neurosurg 1983; 58 (4) 598-601
35 Espinel-Ingroff A, Johnson E, Hockey H, Troke P. Activities of voriconazole, itraconazole and amphotericin B in vitro against 590 moulds from 323 patients in the voriconazole phase III clinical studies. J Antimicrob Chemother 2008; 61 (3) 616-620
36 Inano S, Kimura M, Iida J, Arima N. Combination therapy of voriconazole and terbinafine for disseminated fusariosis: case report and literature review. J Infect Chemother 2013; 19 (6) 1173-1180