title: Cerebral scedosporiosis: an emerging fungal infection in severe neutropenic patients: CT features and CT pathologic correlation.
abstract: 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.
authors.affiliation: Department of Radiology, Hospital Universitario Marqués de Valdecilla, Av. Valdecilla s/n, 39008, Santander, Cantabria, Spain. radmle@humv.es
authors.forename: Enrique
authors.initials: E
authors.lastname: Marco de Lucas
authors.forename: Pablo
authors.initials: P
authors.lastname: Sádaba
authors.forename: Pedro
authors.initials: P
authors.lastname: Lastra García-Barón
authors.forename: María Luisa
authors.initials: ML
authors.lastname: Ruiz Delgado
authors.forename: Jorge
authors.initials: J
authors.lastname: Cuevas
authors.forename: Ricardo
authors.initials: R
authors.lastname: Salesa
authors.forename: Arancha
authors.initials: A
authors.lastname: Bermúdez
authors.forename: Andrés
authors.initials: A
authors.lastname: González Mandly
authors.forename: Agustín
authors.initials: A
authors.lastname: Gutiérrez
authors.forename: Fidel
authors.initials: F
authors.lastname: Fernández
authors.forename: Fernando
authors.initials: F
authors.lastname: Marco de Lucas
authors.forename: Consuelo
authors.initials: C
authors.lastname: Díez
mesh_terms: 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
chemical_list: D003287:Contrast Media