Granulomatous encephalitis caused by Bipolaris hawaiiensis.
We describe a case of granulomatous encephalitis caused by Bipolaris (Drechslera) hawaiiensis in an immunocompetent patient. An 18-year-old man with a seven-month history of seizures and right leg weakness was found by computed tomographic scan to have a left frontoparietal enhancing lesion. Biopsy of the lesion revealed granulomatous inflammation and numerous septate hyphae. Culture of the biopsy specimen yielded a pure culture of B hawaiiensis in four days. Susceptibility studies revealed the organism to be sensitive to amphotericin B (minimal inhibitory concentration [MIC] equals 0.25 mg/L) and miconazole lactate (MIC equals 0.064 mg/L), but resistant to flucytosine (MIC greater than 100 mg/L). No synergy was demonstrated with amphotericin B and flucytosine in vitro. The patient was successfully treated with surgery and systemic and intrathecal amphotericin B therapy, and a negative culture was obtained from a repeated brain biopsy six weeks later.
D000293:Adolescent; D000666:Amphotericin B / Q000627:therapeutic use; D003131:Combined Modality Therapy; D004660:Encephalitis / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy; D006099:Granuloma / Q000209:etiology*; D006429:Hemiplegia / Q000209:etiology; D006801:Humans; D008297:Male; D008825:Miconazole / Q000627:therapeutic use; D009181:Mycoses / Q000000981:diagnostic imaging / Q000188:drug therapy; D012640:Seizures / Q000209:etiology; D014057:Tomography, X-Ray Computed
D008825:Miconazole; D000666:Amphotericin B