title: Successful treatment of a giant isolated cerebral mucormycotic (zygomycotic) abscess using endoscopic debridement: case report and therapeutic considerations.
abstract: BACKGROUND
  Cerebral mucormycosis without rhino-orbital or systemic involvement is an extremely rare condition mostly associated with parenteral drug abuse.
  
  
  METHODS
  We report the case of a 42-year-old woman who presented with hemiparesis of the left side and altered mental status. Neuroradiologic workup demonstrated an inflammatory lesion involving the right basal ganglia. Proton magnetic resonance spectroscopy demonstrated features consistent with a pyogenic abscess. Computed tomography-guided stereotactic biopsy led to the diagnosis of cerebral mucormycosis. Parenteral AMB-L treatment was conducted, but the patient worsened clinically, presenting with a complete hemiplegia, and cerebral magnetic resonance imaging (MRI) scans demonstrated a voluminous abscess formation. Then, under stereotactic guidance, a surgical endoscopic debridement of the abscess cavity associated with the placement of an Ommaya reservoir was performed. Systemic and intralesional treatment with AmB associated with an adjunctive immune therapy was conducted. At 3-year follow-up, the patient had recovered partially from her left hemiplegia, allowing her to walk without help, and cerebral MRI scans showed complete resorption of the abscess.
  
  
  CONCLUSIONS
  Our good results suggest that surgical endoscopic debridement associated with intravenous and intracavitary antifungal therapy might be valuable in treating voluminous deep-seated mucormycotic lesions.
authors: Départamentes de Neurochirurgie, Hôpital Timone, Marseille, France. philippe.metellus@mail.ap-hm.fr
authors: Philippe
authors: P
authors: Metellus
authors: Mehdi
authors: M
authors: Laghmari
authors: Stéphane
authors: S
authors: Fuentes
authors: Alexandre
authors: A
authors: Eusebio
authors: Tarek
authors: T
authors: Adetchessi
authors: Stéphane
authors: S
authors: Ranque
authors: Corinne
authors: C
authors: Bouvier
authors: Henry
authors: H
authors: Dufour
authors: François
authors: F
authors: Grisoli
mesh_terms: D000328:Adult; D000666:Amphotericin B / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use; D001922:Brain Abscess / Q000382:microbiology / Q000473:pathology / Q000628:therapy*; D020314:Central Nervous System Fungal Infections / Q000175:diagnosis / Q000188:drug therapy / Q000601:surgery*; D003646:Debridement; D004724:Endoscopy; D005260:Female; D006801:Humans; D009091:Mucormycosis / Q000175:diagnosis / Q000188:drug therapy / Q000601:surgery*
chemical_list: D000935:Antifungal Agents; D000666:Amphotericin B