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Published on: January 14, 2014
An Intratumoral Phaeohyphomycotic Abscess in a Chemotherapy-Naive IDH-Mutant Glioma: A Mere Coincidence?
Rajalakshmi Poyuran1, Kesavadas Chandrasekharan2, George C Vilanilam3
1Department of Pathology, Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST), Trivandrum, Kerala, India.
Abstract:
Phaeohyphomycotic agents causing central nervous system (CNS) infection is rare and is known to affect immunocompetent individuals. We present a patient with a CNS phaeohyphomycotic abscess that had developed within a temporal lobe glioma. Magnetic resonance imaging (MRI) performed two months prior to the surgery showed only the presence of a neoplasm. However, a repeat MRI in the immediate pre-operative period revealed an additional, likely fungal, lesion. During this interval of 2 months, the patient had received a short course of steroids for suspected encephalitis. The steroid therapy and the CNS tropism of the fungi could have contributed to the CNS mycosis. The intratumoral localization of the fungi could be attributed either to the altered tumour vasculature or to a mere coincidence. Occurrence of CNS mycosis within a high grade glioma is exceedingly rare. A majority of such patients reported in the literature had received chemotherapy for the glioma.
Insights
Central nervous system (CNS) phaeohyphomycosis is rare, especially in immunocompetent individuals. This case highlights a fungal abscess developing within a temporal lobe glioma, possibly influenced by steroid therapy.
Area of Science:
- Neurology
- Mycology
- Infectious Diseases
Background:
- Central nervous system (CNS) infections caused by phaeohyphomycotic agents are uncommon.
- These infections can occur in immunocompetent individuals.
- Fungal infections within brain tumors are exceptionally rare.
Purpose of the Study:
- To report a rare case of CNS phaeohyphomycosis.
- To discuss potential contributing factors to fungal infection development within a brain tumor.
- To highlight the diagnostic challenges and clinical presentation of this rare condition.
Main Methods:
- Case report of a patient with a temporal lobe glioma.
- Review of serial Magnetic Resonance Imaging (MRI) findings.
- Analysis of patient's medical history, including steroid treatment.
Main Results:
- A fungal lesion was identified on repeat MRI, developing within a previously known temporal lobe glioma.
- The patient had received a short course of steroids prior to the detection of the fungal lesion.
- Intratumoral localization of fungi was observed, with potential contributing factors discussed.
Conclusions:
- CNS phaeohyphomycosis occurring within a high-grade glioma is exceedingly rare.
- Steroid therapy and fungal CNS tropism may play a role in the development of CNS mycosis.
- Altered tumor vasculature or coincidence may explain intratumoral fungal localization.
