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Disseminated blastomycosis with an intracranial fungoma in an immunocompetent patient: illustrative case
BACKGROUND: Blastomyces dermatitidis is a fungus endemic to central and southern North America. While infection most commonly results in pneumonia, a small number of infections progress to systemic disease, which may include intracranial lesions. Progression to systemic disease is most common in imm...
Autores principales: | , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
American Association of Neurological Surgeons
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9844530/ https://www.ncbi.nlm.nih.gov/pubmed/36647253 http://dx.doi.org/10.3171/CASE22406 |
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author | Shaffer, Annabelle Johnson, Ryan Guglielmi, Gina Naik, Anant Najafali, Daniel Khan, Amir A. Bellafiore, Frank J. Arnold, Paul M. Hassaneen, Wael |
author_facet | Shaffer, Annabelle Johnson, Ryan Guglielmi, Gina Naik, Anant Najafali, Daniel Khan, Amir A. Bellafiore, Frank J. Arnold, Paul M. Hassaneen, Wael |
author_sort | Shaffer, Annabelle |
collection | PubMed |
description | BACKGROUND: Blastomyces dermatitidis is a fungus endemic to central and southern North America. While infection most commonly results in pneumonia, a small number of infections progress to systemic disease, which may include intracranial lesions. Progression to systemic disease is most common in immunocompromised patients, such as those with human immunodeficiency virus. OBSERVATIONS: The authors present a 44-year-old immunocompetent male who presented following a tonic-clonic seizure. Initial workup revealed a 19-mm enhancing intracranial mass. There was avid uptake of fluorescein sodium, and an en bloc resection of the mass was performed. Histopathology revealed B. dermatitidis. Medical management included amphotericin B and azole therapy. Postoperative recovery was uneventful, and no focal neurological deficits were appreciated. LESSONS: This case highlights the neurosurgical management of a rare intracranial fungal manifestation in an immunocompetent patient. A literature review was also performed to better understand the role of neurosurgery in fungal infections. There were limited cases of intracranial Blastomyces reported in immunocompetent patients, and neurosurgical management varied (no intervention, biopsy, resection) and was underreported. Too few cases are reported to suggest neurosurgical intervention for blastomycosis improves outcomes. Medical management was relatively standard with azole and amphotericin therapy. |
format | Online Article Text |
id | pubmed-9844530 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | American Association of Neurological Surgeons |
record_format | MEDLINE/PubMed |
spelling | pubmed-98445302023-01-19 Disseminated blastomycosis with an intracranial fungoma in an immunocompetent patient: illustrative case Shaffer, Annabelle Johnson, Ryan Guglielmi, Gina Naik, Anant Najafali, Daniel Khan, Amir A. Bellafiore, Frank J. Arnold, Paul M. Hassaneen, Wael J Neurosurg Case Lessons Case Lesson BACKGROUND: Blastomyces dermatitidis is a fungus endemic to central and southern North America. While infection most commonly results in pneumonia, a small number of infections progress to systemic disease, which may include intracranial lesions. Progression to systemic disease is most common in immunocompromised patients, such as those with human immunodeficiency virus. OBSERVATIONS: The authors present a 44-year-old immunocompetent male who presented following a tonic-clonic seizure. Initial workup revealed a 19-mm enhancing intracranial mass. There was avid uptake of fluorescein sodium, and an en bloc resection of the mass was performed. Histopathology revealed B. dermatitidis. Medical management included amphotericin B and azole therapy. Postoperative recovery was uneventful, and no focal neurological deficits were appreciated. LESSONS: This case highlights the neurosurgical management of a rare intracranial fungal manifestation in an immunocompetent patient. A literature review was also performed to better understand the role of neurosurgery in fungal infections. There were limited cases of intracranial Blastomyces reported in immunocompetent patients, and neurosurgical management varied (no intervention, biopsy, resection) and was underreported. Too few cases are reported to suggest neurosurgical intervention for blastomycosis improves outcomes. Medical management was relatively standard with azole and amphotericin therapy. American Association of Neurological Surgeons 2023-01-16 /pmc/articles/PMC9844530/ /pubmed/36647253 http://dx.doi.org/10.3171/CASE22406 Text en © 2023 The authors https://creativecommons.org/licenses/by-nc-nd/4.0/CC BY-NC-ND 4.0 (http://creativecommons.org/licenses/by-nc-nd/4.0/ (https://creativecommons.org/licenses/by-nc-nd/4.0/) ). |
spellingShingle | Case Lesson Shaffer, Annabelle Johnson, Ryan Guglielmi, Gina Naik, Anant Najafali, Daniel Khan, Amir A. Bellafiore, Frank J. Arnold, Paul M. Hassaneen, Wael Disseminated blastomycosis with an intracranial fungoma in an immunocompetent patient: illustrative case |
title | Disseminated blastomycosis with an intracranial fungoma in an immunocompetent patient: illustrative case |
title_full | Disseminated blastomycosis with an intracranial fungoma in an immunocompetent patient: illustrative case |
title_fullStr | Disseminated blastomycosis with an intracranial fungoma in an immunocompetent patient: illustrative case |
title_full_unstemmed | Disseminated blastomycosis with an intracranial fungoma in an immunocompetent patient: illustrative case |
title_short | Disseminated blastomycosis with an intracranial fungoma in an immunocompetent patient: illustrative case |
title_sort | disseminated blastomycosis with an intracranial fungoma in an immunocompetent patient: illustrative case |
topic | Case Lesson |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9844530/ https://www.ncbi.nlm.nih.gov/pubmed/36647253 http://dx.doi.org/10.3171/CASE22406 |
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