Curvularia fungi presenting as a large cranial base meningioma: case report.
OBJECTIVE
Fungal infections are emerging as a growing threat to human health, especially in immunocompromised patients. Candida, Cryptococcus, and Aspergillus are a few of the commonly encountered organisms leading to brain abscesses. In this report, we describe Curvularia geniculata as the causative agent in central nervous system infection.


METHODS
Our review of the literature did not reveal a similar published case of central nervous system infection with this organism. A 35-year-old African-American man presented with obstructive hydrocephalus from a large cranial base lesion. Imaging characteristics on computed tomographic and magnetic resonance imaging scans were consistent with those of a cranial base meningioma.


METHODS
The patient underwent an endoscopic transnasal/transclival approach to the anterior middle cranial base for biopsy and decompression of this lesion. A spindle cell proliferation was observed on frozen section, which favored a diagnosis of meningioma. However, on permanent sections, we identified fungal hyphae with budding. Subsequent biopsies grew Curvularia in fungal cultures. Deoxyribonucleic acid sequencing was used to confirm the identification of the isolate as Curvularia geniculata.


CONCLUSIONS
Limited data are available for in vitro susceptibility testing of Curvularia, and treatment modalities have not yet been standardized. The prognosis is usually poor. Despite being treated with voriconazole and intravenous amphotericin, this patient progressed to multiorgan failure and ultimately died. This is the first reported case of central nervous system infection by Curvularia geniculata.
Singh
Harminder
H
Department of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania 19107, USA. Harmansingh.MD@gmail.com <Harmansingh.MD@gmail.com>
Irwin
Sibyl
S
Falowski
Steven
S
Rosen
Mark
M
Kenyon
Lawrence
L
Jungkind
Donald
D
Evans
James
J
D000328:Adult; D020314:Central Nervous System Fungal Infections / Q000175:diagnosis* / Q000382:microbiology / Q000473:pathology; D003937:Diagnosis, Differential; D006801:Humans; D008297:Male; D008577:Meningeal Neoplasms / Q000175:diagnosis* / Q000382:microbiology / Q000473:pathology; D008579:Meningioma / Q000175:diagnosis* / Q000382:microbiology / Q000473:pathology; D019292:Skull Base Neoplasms / Q000175:diagnosis* / Q000382:microbiology / Q000473:pathology