Central Nervous System Blastomycosis With Multiple Brain Abscesses Presenting as Right Upper Extremity Weakness

Area of Science:

• Mycology
• Infectious Diseases
• Neurology

Background:

• Blastomycosis is a fungal infection caused by *Blastomyces dermatitidis*, a pathogen capable of causing disease in immunocompetent hosts.
• Risk factors include geographic location, outdoor activities near water, and soil disruption.
• Immunosuppression increases the risk of severe and disseminated blastomycosis.

Observation:

• A 79-year-old male presented with progressive right upper extremity weakness and severe odontogenic disease.
• Imaging revealed multiple brain abscesses.
• Cerebral abscesses were culture-positive for *Blastomyces dermatitidis*.

Findings:

• The patient underwent incision and drainage of a large cerebral abscess.
• Initial treatment with intravenous liposomal amphotericin B was poorly tolerated.
• Switching to oral voriconazole resulted in good tolerance and improvement of neurological deficits.

Implications:

• This case underscores the potential for *Blastomyces dermatitidis* to cause central nervous system disease.
• Voriconazole can be an effective and well-tolerated treatment for cerebral blastomycosis.
• Early diagnosis and appropriate antifungal therapy are crucial for managing neurological complications of blastomycosis.