Cerebral scedosporiosis: an emerging fungal infection in severe neutropenic patients: CT features and CT pathologic correlation.
Scedosporium prolificans is an emerging opportunistic fungal agent encountered in severely neutropenic patients. The purpose of this paper is to describe the main cranial CT findings from a retrospective review of six patients (four men and two women, 18-66 years old) afflicted with disseminated infection by S. prolificans with neurological symptoms. They were severely neutropenic and presented with severe respiratory failure and conscience deterioration, with a subsequent 100% mortality. The final diagnosis was established by autopsy (performed in five patients) and blood culture findings. Cranial CT showed multiple low-density lesions in four patients without contrast enhancement located in the basal ganglia and corticomedullary junction. Autopsy findings of these lesions demonstrated necrosis and hyphae proliferation inside brain infarcts. Also, two of the patients had a subarachnoid hemorrhage, but angiography could not be performed. CT and autopsy findings were fairly similar to those encountered in cerebral aspergillosis; however, possibly because of its rapid and fatal evolution, no edema or ring enhancing lesions were encountered. Thus, Scedosporium can be included as a rare but possible cause of invasive fungal disseminated central nervous system infections in severely neutropenic patients.
Marco de Lucas
Enrique
E
Department of Radiology, Hospital Universitario Marqués de Valdecilla, Av. Valdecilla s/n, 39008, Santander, Cantabria, Spain. radmle@humv.es
Sádaba
Pablo
P
Lastra García-Barón
Pedro
P
Ruiz Delgado
María Luisa
ML
Cuevas
Jorge
J
Salesa
Ricardo
R
Bermúdez
Arancha
A
González Mandly
Andrés
A
Gutiérrez
Agustín
A
Fernández
Fidel
F
Marco de Lucas
Fernando
F
Díez
Consuelo
C
D000293:Adolescent; D000328:Adult; D000368:Aged; D001479:Basal Ganglia / Q000473:pathology; D002540:Cerebral Cortex / Q000473:pathology; D002544:Cerebral Infarction / Q000000981:diagnostic imaging / Q000473:pathology; D003287:Contrast Media / Q000008:administration & dosage; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D008526:Medulla Oblongata / Q000473:pathology; D016921:Meningitis, Fungal / Q000000981:diagnostic imaging* / Q000473:pathology; D008875:Middle Aged; D008271:Mycetoma / Q000000981:diagnostic imaging* / Q000473:pathology; D009336:Necrosis; D009503:Neutropenia / Q000175:diagnosis* / Q000473:pathology; D009894:Opportunistic Infections / Q000000981:diagnostic imaging* / Q000473:pathology; D011379:Prognosis; D012131:Respiratory Insufficiency / Q000000981:diagnostic imaging / Q000473:pathology; D021681:Scedosporium; D014057:Tomography, X-Ray Computed
D003287:Contrast Media