Scedosporium apiospermum brain abscess treated with surgery and voriconazole. Case report

Area of Science:

• Mycology
• Infectious Diseases
• Neurology

Background:

• Scedosporium apiospermum, a fungus ubiquitous in soil and water, typically causes cutaneous infections but can lead to invasive disease, particularly in immunocompromised individuals.
• Invasive Scedosporium infections, especially central nervous system (CNS) involvement, are rare and challenging to treat.
• Near-drowning events can serve as a potential route for fungal pathogen entry into the CNS.

Observation:

• A 16-month-old immunocompetent boy developed severe neurological deficits, including spastic quadriparesis, following a near-drowning incident.
• Neuroimaging revealed diffuse hypoxic injury and multiple ring-enhancing brain lesions.
• Fungal culture from a brain lesion aspirate identified Scedosporium apiospermum.

Findings:

• Conventional antifungal therapies provided minimal benefit for the Scedosporium apiospermum CNS infection.
• Treatment with voriconazole, a broad-spectrum triazole with good cerebrospinal fluid penetration, led to clinical improvement and favorable radiological outcomes.
• The patient experienced moderate clinical recovery and good radiological resolution of brain lesions.

Implications:

• This case underscores the potential for Scedosporium apiospermum to cause invasive CNS infections in immunocompetent individuals after near-drowning.
• Voriconazole demonstrates significant therapeutic potential for treating Scedosporium apiospermum central nervous system infections.
• Further research into the management of rare fungal CNS infections post-near-drowning is warranted.