title: [Central nervous system infection caused by Exophiala dermatitidis in a case and literature review].
abstract: OBJECTIVE
  To summarize the clinical features, imaging characteristics, diagnosis and treatment of a case with central nervous system infection caused by Exophiala dermatitidis, as well as to review the related literature.
  
  
  METHODS
  Associated literature and clinical data of an 8-year-old boy who was diagnosed as central nervous system infection caused by Exophiala dermatitidis in Beijing Children's Hospital Affiliated to Capital Medical University and hospitalized twice from 2012 to 2014 were analyzed retrospectively.
  
  
  RESULTS
  The boy was 8 years old with the chief complaint of dizziness for 2 months, intermittent fever for 1 month accompanied with spasm twice. He was diagnosed as bile ducts space-occupying lesions 2 years ago, when the pathological diagnosis was fungal infection. The boy was treated with irregular anti-fungal therapy. Then the boy developed nervous symptoms, impaired consciousness and abnormal physical activity that developed gradually. After hospitalization the cerebral MRI of the boy showed space-occupying lesions accompanied with edema of surrounding area. Filamentous fungi was found by brain biopsy, which was culture positive for Exophiala dermatitidis. After diagnosis the boy was treated with amphotericin B (AMB), voriconazole and 5-Fu, as well as symptomatic treatment. The state of the boy was improved gradually. Two months later, the boy could communicate with others normally and move personally. The lesions and edema seen on the MRI was decreased moderately. Accordingly, the boy was treated with oral voriconazole maintenance treatment for about 1 year and 4 months after discharge. During this period, the state of him was stable without symptoms. The lesions shown by MRI did not disappear but decreased on regular examination. However, recently the disease of the boy progressed again, with dizziness, neck pain, headache and progressive nervous symptoms (intermittent spasm, inability to cough, and impaired consciousness). The boy died at last, even with the active treatment at the second hospitalization. Exophiala dermatitidis was culture-positive again in his CSF, and was confirmed by PCR successfully.
  
  
  CONCLUSIONS
  The central nervous system infection caused by Exophiala dermatitidis is rare. Clinical features of this disease were similar to those of other fungal CNS infection, cerebral MRI of which could show the similar lumpy lesions. Diagnosis of the disease should be based on pathology and culture.
authors.affiliation: Division of Infectious Diseases, Beijing Children's Hospital Affiliated to Capital Medical University, Beijing 100045, China.
authors.forename: Bing
authors.initials: B
authors.lastname: Hu
authors.forename: Shaoying
authors.initials: S
authors.lastname: Li
authors.forename: Huili
authors.initials: H
authors.lastname: Hu
authors.forename: Tianming
authors.initials: T
authors.lastname: Chen
authors.forename: Xin
authors.initials: X
authors.lastname: Guo
authors.forename: Zhixiao
authors.initials: Z
authors.lastname: Zhang
authors.forename: Fang
authors.initials: F
authors.lastname: Dong
authors.forename: Zheng
authors.initials: Z
authors.lastname: Li
authors.forename: Quan
authors.initials: Q
authors.lastname: Wang
authors.forename: Kaihu
authors.initials: K
authors.lastname: Yao
authors.affiliation: Email: liugang10@hotmail.com.
authors.forename: Gang
authors.initials: G
authors.lastname: Liu
mesh_terms: D000666:Amphotericin B / Q000008:administration & dosage; D000935:Antifungal Agents / Q000008:administration & dosage; D001921:Brain / Q000000981:diagnostic imaging / Q000382:microbiology / Q000473:pathology*; D002494:Central Nervous System Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D002555:Cerebrospinal Fluid / Q000382:microbiology; D002648:Child; D004359:Drug Therapy, Combination; D005093:Exophiala / Q000302:isolation & purification*; D017809:Fatal Outcome; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D009181:Mycoses / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D011859:Radiography; D065819:Voriconazole / Q000008:administration & dosage
chemical_list: D000935:Antifungal Agents; D000666:Amphotericin B; D065819:Voriconazole; D005472:Fluorouracil