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1.
Medicine (Baltimore) ; 98(48): e18156, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31770258

RESUMO

RATIONALE: Streptococcus anginosus mostly colonizes the digestive and genitourinary system, including the oropharyngeal region. It commonly causes invasive pyogenic infection, but less likely causes infective endocarditis (IE). PATIENT CONCERNS: An 18-year-old woman who had an underlying mitral valve prolapse without mitral regurgitation presented to our hospital with low-grade fever, left leg weakness, and left abdominal pain. She was diagnosed with brain infarction and microabscess as well as IE. The patient totally recovered after the 6-week course of intravenous antibiotics. DIAGNOSIS: Brain magnetic resonance imaging revealed brain infarction and microabscess. Abdominal computed tomography revealed splenic and left renal infarction. Three sets of blood culture were positive for S anginosus. Transthoracic echocardiogram identified mitral valve prolapse with moderate eccentric mitral valve regurgitation, and a 0.3 × 0.6-cm vegetation was found on the left mitral valve. All of these results meet the modified Duke criteria. INTERVENTIONS: The abdominal pain and left leg weakness were improving after 2 weeks of intravenous antibiotics treatment. No neurological sequelae were noted after completing the 6-week course of medical treatment. OUTCOMES: The patient was successfully treated and discharged after completing the 6-week intravenous antibiotics treatment. LESSONS: IE should be considered in young patients with native valve disease who have prolonged fever. Though S anginosus commonly causes invasive pyogenic infection, patients with native valve disease should be checked for IE.


Assuntos
Antibacterianos/administração & dosagem , Abscesso Encefálico , Infarto Encefálico , Endocardite , Prolapso da Valva Mitral , Infecções Estreptocócicas , Streptococcus anginosus/isolamento & purificação , Administração Intravenosa , Adolescente , Abscesso Encefálico/diagnóstico por imagem , Abscesso Encefálico/tratamento farmacológico , Abscesso Encefálico/etiologia , Infarto Encefálico/diagnóstico por imagem , Infarto Encefálico/etiologia , Ecocardiografia/métodos , Endocardite/complicações , Endocardite/diagnóstico , Endocardite/tratamento farmacológico , Endocardite/microbiologia , Feminino , Humanos , Insuficiência da Valva Mitral/diagnóstico , Insuficiência da Valva Mitral/etiologia , Prolapso da Valva Mitral/complicações , Prolapso da Valva Mitral/diagnóstico por imagem , Recuperação de Função Fisiológica , Infecções Estreptocócicas/complicações , Infecções Estreptocócicas/diagnóstico , Infecções Estreptocócicas/tratamento farmacológico , Resultado do Tratamento
3.
Medicine (Baltimore) ; 98(36): e17044, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31490396

RESUMO

RATIONALE: A single atrium is a rare congenital heart disease (CHD) involving zero atrial septal traces and preserved intact ventricular septum and atrioventricular valves, requiring careful surgical intervention. However, developing to Eisenmenger syndrome (ES) makes the surgery complicated. Based on bidirectional cardiac shunting, vegetation easily develops in case of bacterial infection. PATIENT CONCERN AND DIAGNOSES: We reported a 35-year-old woman with a single atrium, patent ductus arteriosus, pulmonary hypertension, and ES who developed infective endocarditis on her left ventricular outflow tract and complicated cerebral abscess and who underwent challenged medical treatment. INTERVENTION: Infection was successfully controlled after 4-time change in antibiotics over 4 months. However, surgery is complicated for her. OUTCOMES: The patient presented a relatively good outcome during follow-up for >6 months. LESSONS: This case report suggests that patients with complex CHD should accept surgery therapy earlier before developing ES. It is imperative to avoid invasive interventions to prevent infectious endocarditis.


Assuntos
Abscesso Encefálico/complicações , Permeabilidade do Canal Arterial/complicações , Complexo de Eisenmenger/complicações , Endocardite/complicações , Átrios do Coração/anormalidades , Adulto , Antibacterianos/uso terapêutico , Abscesso Encefálico/diagnóstico por imagem , Abscesso Encefálico/tratamento farmacológico , Endocardite/diagnóstico por imagem , Endocardite/tratamento farmacológico , Feminino , Humanos
5.
World Neurosurg ; 132: 29-32, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31450002

RESUMO

BACKGROUND: The use of nonadhesive liquid embolic agents (NALEAs) has gained great popularity in the treatment of brain vascular malformations, with a lower rate of local complications than surgery. However, we describe the formation of brain abscesses after endovascular treatment of a brain arteriovenous malformation (bAVM) and how important removal of the NALEAs was in the treatment of these abscesses. CASE DESCRIPTION: A 68-year-old man presented with seizures after being treated for an unruptured bAVM using Squid (Emboflu), an NALEA. Radiologic imaging revealed brain lesions suspicious of abscesses around the previously treated bAVM. A surgical excision of the bAVM and the embolized material was performed as was drainage of the brain abscesses. Bacterial cultures were positive for Enterococcus faecalis, and the patient left the hospital with an appropriate antibiotic regimen without new deficits. CONCLUSIONS: This is the first reported case of a bAVM treated with Squid complicated with brain abscesses, a rare but very serious complication. This complication should be treated not only using antibiotherapy but with complete safe removal of the embolic material.


Assuntos
Abscesso Encefálico/diagnóstico por imagem , Embolização Terapêutica , Infecções por Bactérias Gram-Positivas/diagnóstico por imagem , Malformações Arteriovenosas Intracranianas/terapia , Polivinil/uso terapêutico , Idoso , Abscesso Encefálico/cirurgia , Enterococcus faecalis , Infecções por Bactérias Gram-Positivas/cirurgia , Humanos , Imagem por Ressonância Magnética , Masculino , Microcirurgia
6.
World Neurosurg ; 131: e226-e236, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31349079

RESUMO

BACKGROUND: Several intracranial pathologies present as a ring-enhancing lesion on conventional magnetic resonance imaging (MRI), creating diagnostic difficulty. We studied the characteristics of the anatomical border of gadolinium enhancement on T1-weighted imaging (WI) and hypointensity on T2WI to employ a simple technique of histogram-profile analysis of MRI for differentiation of various ring-enhancing intracranial lesions. METHODS: After approval from the institutional review board, preoperative MRI (T2WI, postcontrast T1WI) scans were analyzed retrospectively in 18 patients with histologically confirmed brain abscess, 66 glioblastomas, 46 brain-metastases, and 16 tumefactive multiple sclerosis (MS). T2WI and postcontrast T1WI were overlapped, and histogram-profile analysis was performed with in-house image-fusion software. The pattern of differential-peaks in histogram-profile was assessed visually. Kaplan-Meier survival analysis incorporating histogram-profile patterns was performed in patients with glioblastoma. RESULTS: The histogram-profile study revealed 4 distinct patterns. Pattern 1 showed no differential T2-hypointensity trough, pattern 2 had T2-hypointensity trough inside, whereas pattern 3 had T2-hypointensity trough overlapping the enhanced margin. Pattern 4 had T2-hypointensity trough immediately external to the enhanced margin. Pattern 1 was specific for tumefactive MS (93.3%), whereas pattern 4 was specific for glioblastoma (40.7%). Pattern 4 glioblastoma was subdivided into rim (T2-hypointensity ≥50% of circumference of contrast-enhanced tumor) and arc (T2-hypointensity <50% of circumference of contrast-enhanced tumor). Pattern 4 glioblastoma was further subdivided into group A (edema: T2-hyperintensity ≥50% of circumference of contrast-enhanced tumor) and group B (less edema: T2-hyperintensity <50% of circumference of contrast-enhanced tumor). Patients with pattern 3 glioblastoma (37.6%) had better survival compared with others (P = 0.0341) and pattern 4B had decreased survival compared with pattern 4A (P = 0.0001) and others (P = 0.0003). CONCLUSIONS: Tumefactive MS and a subset of glioblastomas show specific patterns in histogram-profile analysis. The difference in anatomical border also determines difference in survival in glioblastoma. Histogram-profile analysis is a simple and efficient technique to differentiate these pathologies.


Assuntos
Abscesso Encefálico/diagnóstico por imagem , Neoplasias Encefálicas/diagnóstico por imagem , Glioblastoma/diagnóstico por imagem , Esclerose Múltipla/diagnóstico por imagem , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Abscesso Encefálico/patologia , Neoplasias Encefálicas/patologia , Neoplasias Encefálicas/secundário , Criança , Meios de Contraste , Diagnóstico Diferencial , Feminino , Gadolínio , Glioblastoma/patologia , Humanos , Processamento de Imagem Assistida por Computador , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Esclerose Múltipla/patologia , Estudos Retrospectivos , Adulto Jovem
7.
Eur J Radiol ; 117: 56-61, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31307653

RESUMO

PURPOSE: The purpose of this retrospective study was to investigate the differentiation of abscess and necrotic tumors, using susceptibility-weighted imaging (SWI) and apparent diffusion coefficients (ADC) either separated or combined. METHODS: Imaging was performed on 26 patients with pyogenic brain abscesses, 31 patients with rim-enhancing glioblastomas, and 21 patients with rim-enhancing metastases. The degree of intralesional susceptibility signal (ILSS) was independently assessed by three observers. Average ADC in the lesion core was calculated. After receiver operating characteristic (ROC) analysis, the area under the ROC curve was compared using three different analytical models (ILSS, ADC, and ILSS-ADC combined) to differentiate abscess from the two rim-enhancing necrotic tumors. RESULTS: The ILSS-ADC combined model had greater area under the ROC curves than ILSS or ADC used alone. In this study, the ILSS-ADC combined model showed 100% diagnostic accuracy differentiating abscesses from glioblastoma. The ADC model and the ILSS-ADC combined model performed equally well in distinguishing abscesses from metastases. CONCLUSION: It is concluded that SWI and ADC are complementary, and the combination of SWI and ADC may improve results compared with the use of only one model. Validation by an independent cohort is the next necessary step to broaden its applicability in routine clinical settings.


Assuntos
Abscesso Encefálico/diagnóstico por imagem , Neoplasias Encefálicas/diagnóstico por imagem , Imagem de Difusão por Ressonância Magnética , Glioblastoma/diagnóstico por imagem , Necrose/diagnóstico por imagem , Adulto , Idoso , Abscesso Encefálico/patologia , Neoplasias Encefálicas/patologia , Diagnóstico Diferencial , Imagem de Difusão por Ressonância Magnética/métodos , Feminino , Glioblastoma/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Necrose/patologia , Estudos Retrospectivos
8.
BMC Vet Res ; 15(1): 183, 2019 Jun 04.
Artigo em Inglês | MEDLINE | ID: mdl-31164122

RESUMO

BACKGROUND: Intracranial abscess formation is an extremely rare and sporadically documented disease in South American Camelids (SACs). Herein we report the first case of otogenic brain abscess formation in this species. CASE PRESENTATION: A 4 years old female alpaca was presented to our veterinary hospital with a 6 month history of neurologic disorder symptoms, mainly head tilt to the right and emaciation. A comprehensive workup (ultrasound and computed tomography) revealed irreversible cranial nerve abnormalities, extensive lesions in the region of external, middle and internal right ear including destruction of bony structures (tympanic bulla, parts of temporal bone) and severe brain deformation caused by an intracranial abscess. The lesion was up to 6x7x4 cm and occupying almost 40% of the cranial cavity. No pathological findings were evident in other organs or structures. The late referral of the alpaca at this advanced stage of destructive disease precluded surgical intervention. CONCLUSIONS: This case report describes the clinical signs, diagnostic procedures and pathological findings in an adult female alpaca suffering from cranial nerve abnormalities caused by a massive otogenic brain abscess. Camelids suffering from otitis may not present with clinical signs until the pathology is severe. The importance of considering intracranial abscess formation as differential diagnosis in SACs showing the merest hint of nerve deficits cannot be emphasized enough in order to diagnose such pathological processes at an early and treatable stage.


Assuntos
Abscesso Encefálico/veterinária , Camelídeos Americanos , Animais , Abscesso Encefálico/diagnóstico por imagem , Abscesso Encefálico/patologia , Feminino , Tomografia Computadorizada por Raios X
9.
BMJ Case Rep ; 12(5)2019 May 31.
Artigo em Inglês | MEDLINE | ID: mdl-31154345

RESUMO

Glioblastoma multiforme (GBM) is an aggressive tumour that can lead to lymphopaenia. Its standard treatment involves temozolomide (TMZ) chemotherapy with radiation, often with addition of corticosteroids for symptomatic management. Although TMZ is also immunosuppressive, patients receiving TMZ rarely develop disseminated opportunistic infections. Here, we report the case of a patient with GBM receiving TMZ, radiotherapy and corticosteroids, who develops an incidental new brain lesion that is found to be disseminated Aspergillus within a new GBM tumour site. The patient received successful early treatment of her central nervous system aspergillosis. This case illustrates the profound immunosuppressive potential of GBM in conjunction with TMZ and corticosteroids, which can lead to high-morbidity opportunistic infections concurrently with tumour progression. Future research is needed to elucidate GBM, TMZ and corticosteroids' compound immune effects and guide management that strikes a balance between treating high-morbidity infections and continuing with immunosuppressive chemotherapy.


Assuntos
Antineoplásicos Alquilantes/uso terapêutico , Aspergilose/diagnóstico , Abscesso Encefálico/diagnóstico , Neoplasias Encefálicas/terapia , Lobo Frontal , Glioblastoma/terapia , Temozolomida/uso terapêutico , Antineoplásicos Alquilantes/administração & dosagem , Antineoplásicos Alquilantes/efeitos adversos , Aspergilose/diagnóstico por imagem , Aspergilose/etiologia , Abscesso Encefálico/diagnóstico por imagem , Abscesso Encefálico/etiologia , Neoplasias Encefálicas/patologia , Terapia Combinada , Diagnóstico Diferencial , Feminino , Glioblastoma/patologia , Humanos , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Temozolomida/administração & dosagem , Temozolomida/efeitos adversos
10.
J Clin Neurosci ; 66: 277-279, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31097380

RESUMO

A 72-year-old man without obvious risk factors initially presented with acute ischemic stroke and fever, without concomitant infection. Broad spectrum antibiotic therapy was initiated. Transthoracic and Transesophageal echocardiography, and cardiac MRI revealed a 20 mm round mass attached to the anterior mitral valve leaflet, suggesting the diagnosis of a benign cardiac tumor or a vegetation. At the site of infarction an abscess of 11 mm in diameter developed 30 days later. The patient underwent surgical valve repair for the prevention of further embolic complications. Histology revealed a cardiac papillary fibroelastoma (PFE). He made complete clinical recovery. Secondary abscess formation after ischemic stroke is rare: 11 other cases have been reported. Because they develop at the site of a previous ischemic infarct, these abscesses usually do not manifest by additional neurologic deficits, making difficult their diagnosis. In most cases a concomitant infection cannot be individualized. Even if these abscesses are a rare entity, patients with cerebral infarct presenting with fever must be closely follow-up with cerebral imaging. Even if PFE is a rare cardiac source of embolic stroke, it should be considered in the differential diagnosis of stroke in a patient where an alternative etiology has not been established.


Assuntos
Abscesso Encefálico/diagnóstico por imagem , Isquemia Encefálica/diagnóstico por imagem , Fibroma/diagnóstico por imagem , Neoplasias Cardíacas/diagnóstico por imagem , Embolia Intracraniana/diagnóstico por imagem , Acidente Vascular Cerebral/diagnóstico por imagem , Idoso , Abscesso Encefálico/complicações , Abscesso Encefálico/cirurgia , Isquemia Encefálica/complicações , Isquemia Encefálica/cirurgia , Diagnóstico Diferencial , Fibroma/cirurgia , Neoplasias Cardíacas/complicações , Neoplasias Cardíacas/cirurgia , Humanos , Embolia Intracraniana/complicações , Embolia Intracraniana/cirurgia , Masculino , Músculos Papilares/diagnóstico por imagem , Músculos Papilares/cirurgia , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/cirurgia
11.
World Neurosurg ; 127: 199-205, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30928576

RESUMO

INTRODUCTION: Endovascular treatment is growing in popularity globally as an important treatment option for intracranial aneurysms. Cerebral infection as a complication of endovascular treatment of aneurysms is sufficiently rare that only 6 isolated cerebral abscess cases have been reported thus far. CASE REPORT: In this report, we present 2 cerebral abscesses from 3 institutions, which developed after coil embolization of anterior communicating artery and middle cerebral artery aneurysms. CONCLUSION: This report was written to discuss the possible mechanisms underlying cerebral abscess after endovascular treatment of aneurysms and to suggest potential treatment and prevention methods.


Assuntos
Abscesso Encefálico/diagnóstico por imagem , Procedimentos Endovasculares/efeitos adversos , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/cirurgia , Complicações Pós-Operatórias/diagnóstico por imagem , Adulto , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Abscesso Encefálico/tratamento farmacológico , Abscesso Encefálico/etiologia , Procedimentos Endovasculares/tendências , Feminino , Humanos , Masculino , Complicações Pós-Operatórias/tratamento farmacológico , Complicações Pós-Operatórias/etiologia , Resultado do Tratamento
12.
World Neurosurg ; 125: 175-178, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30743027

RESUMO

BACKGROUND: At present, the differential diagnosis of magnetic resonance imaging enhancing lesions can still be challenging. Preoperative imaging is a valuable tool characterized by high informative value, even if false-positive and false-negative results are possible. In this context, 5-aminolevulenic acid (5-ALA) represents a significant adjunct in glioblastoma (GBM) surgery displaying an assumed specific accumulation only in tumor cells. However, it was anecdotally reported that in some cases it can also be detected in nonneoplastic lesions mimicking GBM, thus potentially leading to misdiagnosis. Moreover, precise identification of involved pathogens from intraoperative brain samples may remain difficult. We report the case of an abscess from Aggregatibacter mimicking a GBM both during preoperative imaging and intraoperatively, since showing 5-ALA fluorescence. CASE DESCRIPTION: A 54-year-old man presented with intense cephalalgia, vomiting, and scotomas in his left eye. Brain magnetic resonance imaging demonstrated a right temporo-occipital rim-enhancing mass, highly suggestive of a GBM, and for this reason the patient underwent 5-ALA-guided complete removal. Histopathologic analysis proved the lesion to be a bacterial abscess from Aggregatibacter as confirmed by polymerase chain reaction on bacterial deoxyribonucleic acid. CONCLUSIONS: 5-ALA fluorescence may not be specifically involved only in malignant tumor cells, thus raising the suspect for alternative diagnoses to GBM and inviting caution into fluorescence-guided surgery.


Assuntos
Ácido Aminolevulínico , Abscesso Encefálico/diagnóstico por imagem , Infecções por Bactérias Gram-Negativas/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Cirurgia Assistida por Computador/métodos , Aggregatibacter , Abscesso Encefálico/cirurgia , Neoplasias Encefálicas/diagnóstico , Diagnóstico Diferencial , Glioblastoma/diagnóstico , Infecções por Bactérias Gram-Negativas/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade
13.
World Neurosurg ; 125: 327-328, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30771547

RESUMO

Penetrating brain injury is 1 type of traumatic brain injury. Brain abscess is a common complication after penetrating brain injury, and fragments increase the risk of occurrence of brain abscess. It is uncommon to see the migration of bone fragments in the brain in clinical cases. We report a rare case of brain abscess with migration of bone fragments after traumatic brain injury.


Assuntos
Abscesso Encefálico/diagnóstico por imagem , Migração de Corpo Estranho/diagnóstico por imagem , Traumatismos Cranianos Penetrantes/diagnóstico por imagem , Fraturas Cranianas/diagnóstico por imagem , Acidentes de Trânsito , Abscesso Encefálico/etiologia , Abscesso Encefálico/cirurgia , Seguimentos , Migração de Corpo Estranho/complicações , Migração de Corpo Estranho/cirurgia , Traumatismos Cranianos Penetrantes/complicações , Traumatismos Cranianos Penetrantes/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Fraturas Cranianas/complicações , Fraturas Cranianas/cirurgia
16.
Clin Nucl Med ; 44(1): 57-58, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30371581

RESUMO

A 51-year-old woman developed profound coma complicating subarachnoid hemorrhage after aneurysmal rupture. An external ventricular drain was inserted. FDG PET/CT was performed for prognostication purposes and showed global cortical hypometabolism. This was consistent with the clinical findings of an unresponsive wakefulness syndrome. During the follow-up, ventriculitis was diagnosed. Because of no clinical improvement under focused, high-dose antimicrobial treatment, a second FDG PET/CT was performed. It showed an improved diffuse cortical fixation and an intense intraventricular hyperfixation, suggestive of intraventricular abscess. A third functional imaging, performed to monitor treatment, showed progressive metabolic recovery with especially uptake in frontoparietal areas over time.


Assuntos
Abscesso Encefálico/diagnóstico por imagem , Coma/diagnóstico por imagem , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Abscesso Encefálico/complicações , Coma/etiologia , Feminino , Fluordesoxiglucose F18 , Humanos , Pessoa de Meia-Idade , Compostos Radiofarmacêuticos , Vigília
17.
World Neurosurg ; 123: 425-434.e5, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30415043

RESUMO

BACKGROUND: Isolated cerebral mucormycosis is a rare and serious infection associated with intravenous drug abuse. METHODS: We performed a comprehensive meta-analysis of cases reported in studies and have included an unreported case from our institution. We searched PubMed/Medline, EMBASE, Scopus, Cochrane Databases, and our institution's electronic medical health records from inception through March 31, 2018. The cases were considered isolated (only affecting the cerebrum, cerebellum, or brainstem) if the absence of other primary sources of infection had been documented. Continuous variables were summarized using the median and interquartile range and categorical variables using frequencies and proportions. The relationships between variables were tested using the Wilcoxon rank sum and Pearson χ2 tests. RESULTS: A total of 130 studies (141 patients) met the eligibility requirements and were screened; 68 patients were included. The median age was 28 years (interquartile range, 24-38); 57% were men. Most patients had a history of intravenous drug abuse (82%), and 20% had positive human immunodeficiency virus findings. The lesion location was mostly supratentorial (91%), especially in the basal ganglia (71.2%). The cultures were positive in 38%, with Rhizopus the most common organism (59%). The mortality rate was 65%. The survivors were significantly more likely to have received amphotericin B (92% vs. 43%; P < 0.001) or to have undergone stereotactic aspiration (58% vs. 25%; P < 0.01). CONCLUSIONS: Isolated cerebral mucormycosis has a pooled mortality rate of 65%. The presence of lesions in the basal ganglia, rapidly progressive symptoms, and a history of intravenous drug abuse should raise suspicion for the early initiation of amphotericin B and stereotactic aspiration.


Assuntos
Abscesso Encefálico/diagnóstico , Abscesso Encefálico/terapia , Mucormicose , Antifúngicos/uso terapêutico , Abscesso Encefálico/diagnóstico por imagem , Feminino , Humanos , Imagem por Ressonância Magnética , Mucormicose/diagnóstico , Mucormicose/patologia , Mucormicose/terapia , Abuso de Substâncias por Via Intravenosa/etiologia , Adulto Jovem
18.
Folia Microbiol (Praha) ; 64(3): 383-388, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30368648

RESUMO

Cerebral abscesses caused by dark-pigmented Fonsecaea fungi are rare, especially in otherwise healthy individuals. In this case report, we present a 61-year-old man from Moldova, living in the Czech Republic, who had worked as a locksmith on oil platforms in Turkmenistan, Kazakhstan, Sudan, and Iraq since 1999, and was admitted to a neurology ward for a sudden motion disorder of the right leg, dysarthria, and hypomimia. Imaging revealed presence of expansive focus around the left lateral ventricle of the brain and a pronounced peripheral edema. The intracranial infectious focus was excised under intraoperative SonoWand guidance. Tissue samples were histologically positive for dark-pigmented hyphae, suggesting dematiaceous fungi. Therefore, liposomal amphotericin B therapy was initiated immediately. Fonsecaea monophora was provisionally identified using ITS rDNA region sequencing directly from brain tissue. The identification was subsequently confirmed by cultivation and DNA sequencing from culture. The strain exhibited in vitro sensitive to voriconazole (MIC = 0.016 µg/mL) and resistance to amphotericin B (MIC = 4 µg/mL); therefore, the amphotericin B was replaced with voriconazole. Postoperatively, a significant clinical improvement was observed and no additional surgery was required. Based on the literature review, this is the third documented case of cerebral infection due to this pathogen in patients without underlying conditions and the first such case in Europe.


Assuntos
Ascomicetos/isolamento & purificação , Abscesso Encefálico/microbiologia , Abscesso Encefálico/cirurgia , Micoses/diagnóstico , Anfotericina B/uso terapêutico , Antifúngicos/farmacologia , Antifúngicos/uso terapêutico , Ascomicetos/efeitos dos fármacos , Ascomicetos/genética , Abscesso Encefálico/diagnóstico por imagem , República Tcheca , DNA Ribossômico/genética , Humanos , Imunocompetência , Masculino , Pessoa de Meia-Idade , Micoses/diagnóstico por imagem , Resultado do Tratamento
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