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Intracranial blastomycosis presenting as an enhancing cerebellopontine mass

Erinc Akture1, Shahriar Salamat, Mustafa Kemal Baskaya

  • 1University of Wisconsin, Department of Neurological Surgery, Madison, Wisconsin, USA.

Turkish Neurosurgery
|April 3, 2013
PubMed

Insights

A rare central nervous system Blastomyces dermatitidis infection was diagnosed in a patient presenting with severe headache. Early detection through biopsy and cerebrospinal fluid antigen testing is critical for this potentially fatal fungal infection.

Area of Science:

  • Mycology
  • Infectious Diseases
  • Neurology

Background:

  • Central nervous system (CNS) involvement by Blastomyces dermatitidis is rare but potentially fatal.
  • Timely and accurate diagnosis is crucial for effective treatment of CNS blastomycosis.

Observation:

  • A 37-year-old male presented with severe headache and neurological deficits.
  • Magnetic Resonance Imaging (MRI) revealed a cerebellopontine angle mass with extension into the internal acoustic canal and diffuse basilar enhancement.
  • Surgical biopsy confirmed the presence of broad-based budding yeasts consistent with Blastomyces dermatitidis.

Findings:

  • Cerebrospinal fluid (CSF) antigen enzyme immunoassay (EIA) (MVista®) was positive for Blastomyces dermatitidis at 4.28 EIA units.
  • Histopathological examination of the surgical biopsy demonstrated characteristic broad-based budding yeasts.

Implications:

  • This case highlights the importance of considering fungal infections, such as blastomycosis, in the differential diagnosis of CNS masses.
  • The combination of advanced imaging, surgical biopsy, and specific antigen testing aids in the diagnosis of rare CNS fungal infections.
  • Prompt diagnosis and treatment are essential to improve patient outcomes and prevent mortality associated with CNS blastomycosis.

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