title: Intracranial blastomycotic abscess mimicking malignant brain neoplasm: Successful treatment with voriconazole and surgery.
abstract: BACKGROUND
  Cerebral blastomycosis is a rarely reported disease, and in the absence of associated, underlying systemic infection, poses a great diagnostic difficulty. Magnetic resonance imaging can sometimes provide equivocal information when trying to pinpoint a diagnosis. Classically, cerebral blastomycosis has been treated with amphotericin B. Voriconazole is a newer triazole antifungal with potential as a follow-up treatment of blastomycosis of the central nervous system after initial therapy with amphotericin B.
  
  
  METHODS
  We describe one such case of a cerebral blastomycotic abscess, presenting in the absence of any systemic disease, which was initially thought to be a neoplasm. It was successfully treated by surgical resection followed by sequential amphotericin B and voriconazole. The patient did well with voriconazole therapy and was followed for voriconazole tolerance with liver function tests, which continued to be stable at 8 months past the initiation of therapy. At 12 months postoperatively, the patient was doing well and showed gradual improvement in a visual field cut, with no sign of recurrent infection.
  
  
  CONCLUSIONS
  Isolated cerebral blastomycosis can present a diagnostic challenge. In the absence of systemic infection, surgical resection followed by antifungal therapy is a logical treatment plan.
authors.affiliation: Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama, USA.
authors.forename: Kanika
authors.initials: K
authors.lastname: Arora
authors.affiliation: Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama, USA.
authors.forename: Ross L
authors.initials: RL
authors.lastname: Dawkins
authors.affiliation: Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA.
authors.forename: David F
authors.initials: DF
authors.lastname: Bauer
authors.affiliation: Department of Pathology, University of Utah, Salt Lake City, Utah, USA.
authors.forename: Cheryl A
authors.initials: CA
authors.lastname: Palmer
authors.affiliation: Department of Pathology, University of Alabama at Birmingham, Birmingham, Alabama, USA.
authors.forename: James R
authors.initials: JR
authors.lastname: Hackney
authors.affiliation: Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama, USA.
authors.forename: James M
authors.initials: JM
authors.lastname: Markert
keywords: Blastomycotic abscess; cerebral blastomycosis; voriconazole