Chronic Histoplasma capsulatum infection of the central nervous system successfully treated with fluconazole.
A 48-year-old man with a long-standing history of communicating hydrocephalus is reported. Ventriculoperitoneal shunting led to clinical improvement, but symptoms recurred despite surgical re-exploration switching the shunt to an atrial drainage. Ten months after the last surgical procedure, an acute myelopathy developed. Concomitant pharyngeal granuloma examination identified Histoplasma capsulatum (Hc) yeasts. Despite initial response to amphotericin B, Hc was isolated from cerebrospinal fluid (CSF), valve reservoir and distal catheter after two courses of therapy. Fluconazole successfully sterilized CSF, but transverse myelopathy persisted unchanged, and shunting was needed to control hydrocephalus.
Tiraboschi
I
I
Department of Infectious Diseases, Hospital de Clinicas Jose de San Martin, Buenos Aires, Argentina.
Casas Parera
I
I
Pikielny
R
R
Scattini
G
G
Micheli
F
F
D002557:Cerebrospinal Fluid Shunts; D003937:Diagnosis, Differential; D015725:Fluconazole / Q000627:therapeutic use*; D006660:Histoplasmosis / Q000188:drug therapy* / Q000601:surgery; D006801:Humans; D006850:Hydrocephalus, Normal Pressure / Q000188:drug therapy / Q000601:surgery; D008297:Male; D016921:Meningitis, Fungal / Q000188:drug therapy* / Q000601:surgery; D008875:Middle Aged; D010537:Peritoneum; D011183:Postoperative Complications / Q000188:drug therapy / Q000601:surgery; D012086:Reoperation; D014057:Tomography, X-Ray Computed
D015725:Fluconazole