Candida brain abscesses in a patient with anorexia nervosa receiving total parenteral nutrition

A 28-year-old woman with anorexia nervosa (AN) and Candida brain abscesses was transferred to our hospital for intensive treatment. On admission, she had a low-grade fever but no clinical neurological abnormalities were observed, even though she had a high-grade fever in the previous hospital. These clinical findings did not suggest a serious disorder in the brain. However, magnetic resonance imaging showed mass lesions in bilateral lentiform nuclei in addition to several abscesses in the whole body. The fungal cultures of specimens from abscesses on the anterior chest wall and iliopsoas muscle detected Candida albicans. She was treated with antifungal therapy (fosfluconazole, fluconazole, liposomal amphotericin B, and flucytosine) and two emergent craniotomies for drainage of the intracranial fluid. Thereafter, antifungal medications (voriconazole and flucytosine) were administered for six months as a longterm treatment, which abolished most abscesses. However, severe frontal lobe dysfunction persisted as a residual symptom. This case suggests that AN can mask clinical manifestations of infection. We should always consider the possibility of infectious complications in these patients.