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[An autopsy case of fungal (Mucor) cerebral aneurysm]
1Second Department of Internal Medicine, School of Medicine, Teikyo University.
Abstract:
An autopsy of rupture of Mucor cerebral aneurysm, not diagnosed during the patient's life, was experienced. A 63-year-old female was admitted to our hospital with the chief complaint of disturbance of consciousness and high fever. Her past histories were diabetes mellitus, liver cirrhosis and nasal sinusitis. The remarkable findings on admission were moderate inflammatory data, high blood sugar level in serum and ascites. Brain CT film revealed a non-enhanced low-density area in the frontal region. The cerebrospinal fluid showed bloody color and white blood cell counts were 3300/microliter (mostly neutrophils). Under our suspected of bacterial encephalomeningitis, intravenous cefotaxime and ampicillin therapy was started immediately. Cultures of cerebrospinal fluid for bacteria were negative. The disturbance of her consciousness gradually improved under general treatment. However, her conscious level suddenly became a coma on the 6th hospital day and she died on the 9th hospital day. An autopsy revealed Mucor at the site of the rupture of the cerebral aneurysm.
Insights
A rare autopsy case revealed Mucor cerebral aneurysm rupture in a diabetic patient with liver cirrhosis and sinusitis. This fungal infection, initially suspected as bacterial meningitis, led to a fatal outcome despite treatment.
Area of Science:
- Neurology
- Infectious Diseases
- Pathology
Background:
- A 63-year-old female with diabetes mellitus, liver cirrhosis, and nasal sinusitis presented with altered consciousness and fever.
- Initial assessment revealed inflammatory markers, hyperglycemia, ascites, and a frontal lobe low-density area on CT scan.
Observation:
- Cerebrospinal fluid analysis showed bloody fluid with elevated white blood cell counts, initially leading to a diagnosis of bacterial encephalomeningitis.
- Despite broad-spectrum antibiotic treatment and initial improvement, the patient's condition rapidly deteriorated, progressing to coma and death.
Findings:
- Autopsy identified Mucor at the site of a ruptured cerebral aneurysm, a diagnosis not made during the patient's lifetime.
- Cultures for bacteria from cerebrospinal fluid were negative, ruling out bacterial meningitis as the primary cause.
Implications:
- This case highlights the critical importance of considering rare fungal infections like Mucor in immunocompromised patients presenting with neurological symptoms.
- Delayed or missed diagnosis of Mucor cerebral aneurysm can have devastating consequences, underscoring the need for advanced diagnostic approaches.