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Intracranial blastomycotic abscess mimicking malignant brain neoplasm: Successful treatment with voriconazole and surgery

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 bla...

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Autores principales: Arora, Kanika, Dawkins, Ross L., Bauer, David F., Palmer, Cheryl A., Hackney, James R., Markert, James M.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Medknow Publications & Media Pvt Ltd 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4665129/
https://www.ncbi.nlm.nih.gov/pubmed/26673672
http://dx.doi.org/10.4103/2152-7806.170025
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author Arora, Kanika
Dawkins, Ross L.
Bauer, David F.
Palmer, Cheryl A.
Hackney, James R.
Markert, James M.
author_facet Arora, Kanika
Dawkins, Ross L.
Bauer, David F.
Palmer, Cheryl A.
Hackney, James R.
Markert, James M.
author_sort Arora, Kanika
collection PubMed
description 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. CASE DESCRIPTION: 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.
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spelling pubmed-46651292015-12-15 Intracranial blastomycotic abscess mimicking malignant brain neoplasm: Successful treatment with voriconazole and surgery Arora, Kanika Dawkins, Ross L. Bauer, David F. Palmer, Cheryl A. Hackney, James R. Markert, James M. Surg Neurol Int Case Report 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. CASE DESCRIPTION: 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. Medknow Publications & Media Pvt Ltd 2015-11-20 /pmc/articles/PMC4665129/ /pubmed/26673672 http://dx.doi.org/10.4103/2152-7806.170025 Text en Copyright: © 2015 Surgical Neurology International http://creativecommons.org/licenses/by-nc-sa/3.0 This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
spellingShingle Case Report
Arora, Kanika
Dawkins, Ross L.
Bauer, David F.
Palmer, Cheryl A.
Hackney, James R.
Markert, James M.
Intracranial blastomycotic abscess mimicking malignant brain neoplasm: Successful treatment with voriconazole and surgery
title Intracranial blastomycotic abscess mimicking malignant brain neoplasm: Successful treatment with voriconazole and surgery
title_full Intracranial blastomycotic abscess mimicking malignant brain neoplasm: Successful treatment with voriconazole and surgery
title_fullStr Intracranial blastomycotic abscess mimicking malignant brain neoplasm: Successful treatment with voriconazole and surgery
title_full_unstemmed Intracranial blastomycotic abscess mimicking malignant brain neoplasm: Successful treatment with voriconazole and surgery
title_short Intracranial blastomycotic abscess mimicking malignant brain neoplasm: Successful treatment with voriconazole and surgery
title_sort intracranial blastomycotic abscess mimicking malignant brain neoplasm: successful treatment with voriconazole and surgery
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4665129/
https://www.ncbi.nlm.nih.gov/pubmed/26673672
http://dx.doi.org/10.4103/2152-7806.170025
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