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Candida Albicans Dural Granuloma: Case Report
Alessandro Di Rienzo1, Maurizio Iacoangeli1, Niccolò Nocchi1
1Department of Neurosurgery, Universita' Politecnica delle Marche, Umberto I General Hospital, Ancona, Italy.
Insights
A rare case of Candida albicans granuloma exclusively within the dura mater was successfully treated with surgery and antifungal therapy. This unique presentation highlights the importance of prolonged observation for potential complications.
Area of Science:
- Neurology
- Infectious Diseases
- Surgical Pathology
Background:
- Candida albicans can disseminate to the central nervous system (CNS) in immunocompromised individuals.
- Intracerebral lesions are common, but meningeal or cerebrospinal fluid involvement is rare.
- This case presents a unique intradural granuloma, distinct from typical CNS candidiasis.
Observation:
- A 75-year-old male with a history of Candida albicans urinary sepsis presented with acute neurological deficits.
- Imaging revealed a large fronto-parietal mass causing significant brain compression.
- The lesion was surgically excised and pathologically confirmed as an intradural Candida albicans granuloma.
Findings:
- Complete surgical removal of the intradural granuloma was achieved.
- Post-operative antifungal therapy was initiated.
- The patient experienced an uneventful recovery from surgery but later developed a bone flap infection requiring further intervention.
Implications:
- Isolated intradural Candida albicans granuloma is a previously undescribed entity.
- Surgical excision can resolve mass effect, but prolonged follow-up is crucial.
- Potential for delayed complications, such as bone flap infection, necessitates vigilant monitoring.
Abstract:
Candida albicans dissemination to the central nervous system (CNS) may occur in immunocompromised patients even without prior cranial surgery. In such cases, intracerebral lesions are most frequent, meningeal or cerebrospinal fluid involvement being rare. We, here, describe a case of Candida albicans granuloma developing exclusively inside the width of the dura mater, successfully treated by surgical excision followed by antimycotic therapy. A 75-year-old man, previously affected by urinary sepsis from Candida albicans, was admitted to the emergency department of our hospital because of the acute appearance of sensory obtundation, blurred speech, and right hemiparesis. Emergency computed tomography (CT) scan and magnetic resonance imaging (MRI) with and without contrast enhancement disclosed a huge, left fronto-parietal mass, causing severe brain compression. At surgery, the lesion appeared to develop exclusively inside the dural envelope, and was completely removed. At pathology, a totally intradural Candida albicans granuloma was observed and appropriate antimycotic treatment was started. After an uneventful postoperative course the patient was sent to rehabilitation. Five months later he was admitted again because of a bone flap infection, leading to bone removal and further cranioplasty, with full neurological recovery. At 2 years follow-up, no neuroradiological or clinical evidence of residual/relapsing intracranial infection was found. Isolated intradural granuloma from Candida albicans has never been described before. Even though surgical excision may lead to complete resolution of mass effect in these patients, prolonged observation should be maintained, to disclose further, potentially lethal, complications.
