[Fungal meningitis caused by a Malassezia species masquerading as painful ophthalmoplegia].
The patient, an otherwise healthy 42-year-old woman, developed non-throbbing periorbital pain and abducens nerve palsy of the right side two weeks prior to the present admission. Under the diagnosis of Tolosa-Hunt syndrome, she had been placed on prednisolone (30 mg/day) in another hospital, leading to exacerbation of her neurologic manifestations. On admission, neurologic examination revealed bilateral abducens nerve palsy, incomplete bilateral oculomotor paresis, and hypalgesia in the first and the second branch of the left trigeminal nerve. On CSF examination there were 742/mm3 white blood cells of which about 80% of the cells were neutrophils. The glucose was 70 mg/dl (blood glucose was 170 mg/dl) and the protein 49 mg/dl. Although repeated cultures for bacteria or fungi were negative, PAS stains for CSF sediments showed a large number of yeasts morphologically consistent with a Malassezia species. Anti-fungal treatment with fluconazole and flucytosine resulted in dramatic improvement both in neurologic signs and laboratory findings. According to morphological criteria, the yeasts found in CSF sediments from this patient differed from those described previously as being pathogenetic in the CNS fungal infection. By contrast, these yeasts were similar to a Malassezia species in all aspects. Because some Malassezia requires oil for its growth in culture, it is possible that it failed to grow in the standard media and thus escaped recognition.
Aoba
S
S
Department of Neurology, Yokohama City University School of Medicine.
Komiyama
A
A
Hasegawa
O
O
D000328:Adult; D000900:Anti-Bacterial Agents; D004359:Drug Therapy, Combination / Q000627:therapeutic use; D005260:Female; D015725:Fluconazole / Q000627:therapeutic use; D005437:Flucytosine / Q000627:therapeutic use; D006801:Humans; D008290:Malassezia; D016921:Meningitis, Fungal / Q000188:drug therapy / Q000382:microbiology*; D009181:Mycoses / Q000188:drug therapy / Q000382:microbiology*; D009886:Ophthalmoplegia / Q000209:etiology*
D000900:Anti-Bacterial Agents; D015725:Fluconazole; D005437:Flucytosine