Concomitant tubercular and fungal cerebellar abscess in an immunocompromised girl.
Concomitant tubercular and fungal cerebellar abscess is rare and we report the     first concomitant recurrent multi-lobulated tubercular and fungal cerebellar     abscess in an immunocompromised girl with Histiocytosis-X. She presented with     cerebellar abscess history diagnosed during the ongoing treatment for     tuberculous meningitis. The abscess was drained. Upon the detection of     cerebellar abscess recurrence and pulmonary infection, she was referred to our     clinic five weeks after the first surgical intervention. Patient was conscious,     co-operating but confused. She had severe cachexia, stiff neck and fever. Fundus     examination showed bilateral papilledema. Cranial MR images revealed multiple     lobulated lesions. Suboccipital craniectomy was performed and abscess was     evacuated in toto. Lesion was multi-lobulated. Thick, yellow-gray purulent     material was drained. Histopathological examinations yielded Langhans giant     cells,budding and branching fungal structures. Fungal infection was identified.     We emphasize that posterior decompression and total resection should be     considered first in the management of lesions with mass effect in the posterior     fossa. Also the presence of concomitant fatal fungal abscess highlights that     although the clinic and former diagnoses of the patient may direct the clinician     to a certain pathogen, unusual resistant organisms should not be.
GATA Haydarpasa Training Hospital, Department of Neurosurgery, Istanbul, Turkey. drhakansimsek@gmail.com
Hakan
H
Simsek
Murat
M
Kutlay
Ahmet
A
Colak
Aptullah
A
Haholu
Hatice
H
Kaya
Mustafa
M
Ozyurt
Mehmet Nusret
MN
Demircan
D000293:Adolescent; D001922:Brain Abscess / Q000382:microbiology* / Q000473:pathology / Q000601:surgery; D002526:Cerebellar Diseases / Q000382:microbiology* / Q000473:pathology / Q000601:surgery; D003399:Craniotomy; D004322:Drainage; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D008279:Magnetic Resonance Imaging; D009181:Mycoses / Q000150:complications* / Q000276:immunology / Q000473:pathology; D009894:Opportunistic Infections / Q000150:complications* / Q000276:immunology / Q000473:pathology; D016862:Tuberculoma, Intracranial / Q000150:complications* / Q000473:pathology / Q000601:surgery