Fungal cerebral abscess in a diabetic patient successfully treated with surgery followed by prolonged antifungal therapy.
BACKGROUND
Intracranial fungal masses are uncommon diseases, but their incidence is increasing, most often due to the prolonged survival of patients with different immunodeficiencies. The management of patients with intracranial fungal masses included stereotactic biopsy for diagnosis, partial or radical surgery excision and prolonged antifungal therapy.


OBJECTIVE
We report the case of a 51-year-old diabetic man with a history of psoas abscess due to Candida albicans 1 year before the onset of neurological symptoms, including headache and generalized tonoclonic seizures.


METHODS
Magnetic resonance imaging showed a single lesion located in the right parietal lobe with mass effect, surrounding edema and enhancement after injection of gadolinium. The material was purulent.


RESULTS
Direct microscopic examination showed hyaline, branched and septate hyphae compatible with fungal elements.


CONCLUSIONS
Fungal infections, especially due to Candida species, should be considered in diabetic patients with parenchymal brain abscesses. Radical excision followed by prolonged antifungal therapy based on fluconazole or amphotericin B is necessary to improve the prognosis of this type of patients.
Yampolsky
Claudio
C
Department of Infectious Diseases, F.J. Muñiz Hospital, Buenos Aires, Argentina. claudioyampolsky@fibertel.com.ar
Corti
Marcelo
M
Negroni
Ricardo
R
D000666:Amphotericin B / Q000008:administration & dosage / Q000627:therapeutic use*; D000935:Antifungal Agents / Q000627:therapeutic use*; D001922:Brain Abscess / Q000150:complications / Q000188:drug therapy / Q000601:surgery*; D002176:Candida albicans / Q000302:isolation & purification; D002177:Candidiasis / Q000150:complications / Q000188:drug therapy / Q000601:surgery*; D003131:Combined Modality Therapy; D003399:Craniotomy; D003840:Deoxycholic Acid / Q000008:administration & dosage / Q000627:therapeutic use*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D004338:Drug Combinations; D004359:Drug Therapy, Combination; D015725:Fluconazole / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D025301:Hyphae / Q000302:isolation & purification; D008279:Magnetic Resonance Imaging; D008297:Male; D008353:Mannitol / Q000627:therapeutic use; D008875:Middle Aged; D010296:Parietal Lobe / Q000382:microbiology*; D016659:Psoas Abscess / Q000150:complications / Q000382:microbiology
D000935:Antifungal Agents; D004338:Drug Combinations; D003840:Deoxycholic Acid; D008353:Mannitol; D000666:Amphotericin B; C059765:amphotericin B, deoxycholate drug combination; D015725:Fluconazole