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Fungal meningoencephalitis caused by Alternaria: a clinical case

Cícero J C Silveira1, Joana Amaral, Rodrigo P Gorayeb

  • 1Neurosurgery Service, Hospital Egas Moniz - Centro Hospitalar de Lisboa Ocidental, EPE, Lisbon, Portugal. cjeancs@yahoo.com.br

Clinical Drug Investigation
|February 6, 2013
PubMed

Insights

This study reports a rare case of cerebral phaeohyphomycosis in an immunocompetent young man caused by Alternaria alternata. Effective treatment involved combination antifungal therapy, leading to symptom suppression and no recurrence.

Area of Science:

  • Neurology
  • Infectious Diseases
  • Mycology

Background:

  • Cerebral phaeohyphomycosis is a rare and often fatal fungal infection of the brain.
  • It typically affects immunocompromised individuals, making this case in an immunocompetent host highly unusual.

Observation:

  • An 18-year-old immunocompetent male presented with severe meningoencephalitis and arachnoiditis.
  • The condition was linked to difficult-to-treat hydrocephalus and diagnosed via fungal culture and histopathology.
  • The causative agent was identified as Alternaria alternata.

Findings:

  • Initial empirical treatment with liposomal amphotericin B and voriconazole showed a positive response.
  • Subsequent targeted therapy with posaconazole and flucytosine effectively suppressed the fungal infection's signs and symptoms.
  • A 12-month follow-up confirmed no recurrence of the cerebral mycosis.

Implications:

  • This case highlights the importance of considering rare fungal infections like cerebral phaeohyphomycosis even in immunocompetent patients.
  • Successful management underscores the efficacy of aggressive combination antifungal therapy tailored to specific fungal pathogens.
  • The findings contribute to understanding treatment strategies for uncommon central nervous system mycoses.

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