title: Resolution of a fungal mycotic aneurysm after a contaminated steroid injection: a case report.
abstract: BACKGROUND
  In the past ten years there have been three separate outbreaks of fungal contaminated steroid injections from compounding pharmacies. The 2012 outbreak of central nervous system fungal infections associated with contaminated methylprednisolone produced by a United States compounding pharmacy has led to 750 infections (151 with meningitis and paraspinal infections and 325 cases with paraspinal infections without meningitis) and 64 deaths as of October 23, 2013. Exserohilum rostratum has been the predominant pathogen identified by culture, polymerase chain reaction or antibody tests. According to previous reports, cerebral involvement with phaeohyphomycosis has a high risk of morbidity and mortality.
  
  
  METHODS
  We report a 41 year-old Caucasian woman who received a lumbar methylprednisolone injection from a contaminated lot in August 2012. She was diagnosed with fungal meningitis by cerebrospinal fluid pleocytosis and positive (1, 3) beta-D-glucan after cultures and polymerase chain reaction were negative. Two weeks after onset of therapy, she developed a 4.1 mm superior cerebellar artery mycotic aneurysm associated with new stroke symptoms, which resolved with thirty-two weeks of antifungal treatment.
  
  
  CONCLUSIONS
  This is the rare case report of successful medical management of a cerebral mycotic aneurysm with stroke symptoms related to a presumed phaeohyphomycosis in an immunocompetent individual. Further studies are needed to determine the utility of cerebrospinal fluid (1, 3) beta-D-glucan in diagnosing and monitoring patients with meningitis thought to be related to fungal infection.
authors.forename: George
authors.initials: G
authors.lastname: Nelson
authors.forename: Olga
authors.initials: O
authors.lastname: Fermo
authors.forename: Kiran
authors.initials: K
authors.lastname: Thakur
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Felton
authors.forename: Jee
authors.initials: J
authors.lastname: Bang
authors.forename: Lucy
authors.initials: L
authors.lastname: Wilson
authors.forename: Susan
authors.initials: S
authors.lastname: Rhee
authors.forename: Rafael
authors.initials: R
authors.lastname: Llinas
authors.forename: Kristine
authors.initials: K
authors.lastname: Johnson
authors.affiliation: Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA. dsulliva@jhsph.edu.
authors.forename: David
authors.initials: D
authors.lastname: Sullivan
mesh_terms: D000328:Adult; D000783:Aneurysm / Q000150:complications / Q000188:drug therapy*; D000935:Antifungal Agents / Q000627:therapeutic use; D005260:Female; D006801:Humans; D016921:Meningitis, Fungal / Q000150:complications / Q000188:drug therapy*; D009181:Mycoses / Q000150:complications / Q000188:drug therapy*; D065819:Voriconazole / Q000627:therapeutic use
chemical_list: D000935:Antifungal Agents; D065819:Voriconazole