title: [Foot injury as a rare cause of scendosporiosis with fetal outcome].
abstract: After an attempted suicide with a fall from a height of 5 m, a 33 year old male suffered a subarachnoidal haemorrhage, an instable fracture of the second lumbar vertebra as well as a soft-tissue decollément in the vicinity of the right heel. Despite surgical management, the comatose patient showed slow wound-healing of the heel, making revision-surgery necessary 10 days after the first treatment. Fungi were histologically recognised, and subsequent culturing identified Scedosporium apiospermum. Systemic antimycotic therapy with itraconazol (800 mg/d) was immediately initiated. Despite this, S. apiospermum was repeatedly found in wound swabs over the following 2 weeks. After 4 weeks, a radiographically verified osteomyelitis of the calcaneus was diagnosed and local debridement was once again performed. After 5 days, an MRI of the cranium suggested an abscess in the posterior horn of the left lateral ventricle. Itraconazol was altered to voriconazol (4 mg/kg body weight). Neurosurgical opening of the abscess and subsequent culturing once again showed S. apiospermum. CT-scans performed over the following period showed an increase in lesions in the brain suggestive for numerous abscesses. At 78 days after the initial trauma, the still comatose patient died due to a massive cerebral haemorrhage. Microbiological assessment of the soil at the site of injury revealed S. apiospermum.
authors.affiliation: Orthopädische Universitätsklinik, Rheinische Friedrich-Wilhelms-Universität, Bonn. peter.pennekamp@uni-bonn.de
authors.forename: P H
authors.initials: PH
authors.lastname: Pennekamp
authors.forename: O
authors.initials: O
authors.lastname: Diedrich
authors.forename: H
authors.initials: H
authors.lastname: Zhou
authors.forename: C N
authors.initials: CN
authors.lastname: Kraft
mesh_terms: D000328:Adult; D001921:Brain / Q000473:pathology; D001922:Brain Abscess / Q000473:pathology; D003646:Debridement; D062109:Dermatologic Surgical Procedures; D017809:Fatal Outcome; D018409:Foot Injuries / Q000473:pathology / Q000601:surgery*; D006365:Heel / Q000293:injuries* / Q000473:pathology / Q000601:surgery; D006801:Humans; D008297:Male; D009104:Multiple Trauma / Q000473:pathology / Q000601:surgery*; D008271:Mycetoma / Q000473:pathology*; D010019:Osteomyelitis / Q000473:pathology*; D021681:Scedosporium; D012867:Skin / Q000293:injuries* / Q000473:pathology; D013406:Suicide, Attempted; D013530:Surgical Wound Infection / Q000473:pathology*