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Multiple brain abscesses due to Penicillium spp infection
Danilo Teixeira Noritomi1, Guilherme Linhares Bub, Idal Beer
1Gastroenterology Department, Hospital das Clínicas, Medical School, University of São Paulo, São Paulo, SP, Brazil.
Revista Do Instituto De Medicina Tropical De Sao Paulo
|July 16, 2005
Summary
This case report details a rare central nervous system (CNS) infection caused by Penicillium species in an immunocompetent patient. Despite initial treatment, the patient succumbed to complications, highlighting the potential severity of invasive fungal infections.
Area of Science:
- Mycology
- Infectious Diseases
- Neurology
Background:
- Penicillium species, commonly known for superficial or allergic infections, can rarely cause invasive disease.
- Systemic penicilliosis, primarily caused by Penicillium marneffei, is a significant opportunistic infection in Human Immunodeficiency Virus (HIV)-positive individuals in Southeast Asia.
- Infections by Penicillium species other than P. marneffei are uncommon, with invasive central nervous system (CNS) disease being exceedingly rare.
Observation:
- A Human Immunodeficiency Virus (HIV)-negative man in Brazil presented with neurological symptoms including visual field loss and speech disturbances.
- Computed Tomography (CT) scan revealed multiple brain abscesses, indicative of a localized infection within the brain.
- Stereotactic biopsies confirmed a fungal infection, leading to the initiation of amphotericin B treatment.
Findings:
- The patient experienced initial improvement with amphotericin B therapy.
- Despite treatment, the patient unfortunately died due to massive gastrointestinal bleeding from ruptured esophageal varices.
- Post-mortem examination and microbiological analysis confirmed the causative agent as Penicillium species, marking the fourth reported case of Penicillium spp. CNS infection.
Implications:
- This case underscores the potential for non-P. marneffei Penicillium species to cause severe invasive CNS infections, even in immunocompetent individuals.
- It highlights the importance of considering rare fungal pathogens in the differential diagnosis of brain abscesses, particularly in endemic or previously unrecognized regions.
- Further research is warranted to understand the pathogenesis and optimal management strategies for invasive CNS infections caused by diverse Penicillium species.