title: A Rare Central Nervous System Fungal Infection Resulting from Brown Heroin Use.
abstract: BACKGROUND
  Fungal nervous system infection can be a difficult diagnosis to make, due to the fact that there are no specific manifestations of the disease and laboratory confirmation is difficult to confirm.
  
  
  METHODS
  We report a young male who presented to our emergency department with a variety of unilateral visual field complaints. While he initially denied recent IV drug abuse, his physical examination was highly suggestive of a fungal infection known to result from brown heroin use. He was ultimately diagnosed with meningitis, ventriculitis, and endogenous endophthalmitis believed to result from a Candida species. The response to treatment with vitrectomy and broad-spectrum antimicrobials gave support to the presumed diagnosis. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: We provide a rarely described report of a possible complication from the use of IV brown heroin that led to a central nervous system infection involving vision loss by fungal infection.
authors.affiliation: Department of Emergency Medicine, Geisinger Medical Center, Danville, Pennsylvania.
authors.forename: Eric M
authors.initials: EM
authors.lastname: Melnychuk
authors.affiliation: Department of Emergency Medicine, Geisinger Medical Center, Danville, Pennsylvania.
authors.forename: David P
authors.initials: DP
authors.lastname: Sole
mesh_terms: D000935:Antifungal Agents / Q000494:pharmacology / Q000627:therapeutic use; D002175:Candida / Q000472:pathogenicity; D002493:Central Nervous System Diseases / Q000209:etiology*; D058565:Cerebral Ventriculitis / Q000209:etiology; D003937:Diagnosis, Differential; D004636:Emergency Service, Hospital / Q000458:organization & administration; D009877:Endophthalmitis / Q000209:etiology; D003932:Heroin / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008581:Meningitis / Q000209:etiology; D009181:Mycoses / Q000150:complications*; D015819:Substance Abuse, Intravenous / Q000150:complications; D014794:Visual Fields / Q000502:physiology; D065819:Voriconazole / Q000494:pharmacology / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D000935:Antifungal Agents; D003932:Heroin; D065819:Voriconazole
keywords: brown heroin; candida; endophthalmitis; meningitis; ventriculitis