Candida Albicans Dural Granuloma: Case Report

Candida albicans dissemination to the central nervous system (CNS) may occur in immunocompromised patients even without prior cranial surgery. In such cases, intracerebral lesions are most frequent, meningeal or cerebrospinal fluid involvement being rare. We, here, describe a case of Candida albicans granuloma developing exclusively inside the width of the dura mater, successfully treated by surgical excision followed by antimycotic therapy. A 75-year-old man, previously affected by urinary sepsis from Candida albicans, was admitted to the emergency department of our hospital because of the acute appearance of sensory obtundation, blurred speech, and right hemiparesis. Emergency computed tomography (CT) scan and magnetic resonance imaging (MRI) with and without contrast enhancement disclosed a huge, left fronto-parietal mass, causing severe brain compression. At surgery, the lesion appeared to develop exclusively inside the dural envelope, and was completely removed. At pathology, a totally intradural Candida albicans granuloma was observed and appropriate antimycotic treatment was started. After an uneventful postoperative course the patient was sent to rehabilitation. Five months later he was admitted again because of a bone flap infection, leading to bone removal and further cranioplasty, with full neurological recovery. At 2 years follow-up, no neuroradiological or clinical evidence of residual/relapsing intracranial infection was found. Isolated intradural granuloma from Candida albicans has never been described before. Even though surgical excision may lead to complete resolution of mass effect in these patients, prolonged observation should be maintained, to disclose further, potentially lethal, complications.