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Pokhraj Prakashchandra Suthar1, Murali Nagarajan1, Sudeep Bhabad1

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A 76-year-old woman with autoimmune conditions developed a serious infection of the brain and sinuses. Prompt diagnosis and treatment with antibiotics and antifungals led to recovery.

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Area of Science:

  • Infectious Diseases
  • Neurology
  • Rheumatology

Background:

  • A 76-year-old woman with rheumatoid arthritis, Sjögren syndrome, and hypertension presented with headache, fever, and dysphagia.
  • The patient was on prednisone and leflunomide for rheumatoid arthritis management.
  • Initial investigations, including lumbar puncture and temporal artery biopsy, were negative.

Observation:

  • Elevated inflammatory markers (C-reactive protein, erythrocyte sedimentation rate) and brain-type natriuretic peptide were noted.
  • Cerebrospinal fluid analysis revealed cloudy fluid with elevated protein and low glucose.
  • Brain and paranasal sinus imaging (MRI, CT) identified a preclival fluid collection.

Findings:

  • Cultures from the drained preclival fluid collection identified *Candida albicans*, *Pseudomonas*, and *Enterobacter aerogenes*.
  • The patient's symptoms, including dysphagia attributed to cranial nerve dysfunction, improved with treatment.
  • Follow-up MRI after two weeks showed resolution of the fluid collection.

Implications:

  • This case highlights the importance of considering invasive fungal and bacterial infections in immunocompromised patients presenting with neurological symptoms.
  • Multimodal imaging and microbiological analysis are crucial for diagnosing complex infections involving the central nervous system and sinuses.
  • Appropriate and timely antimicrobial therapy, including antifungal and broad-spectrum antibiotics, is essential for favorable outcomes.