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Scedosporium apiospermum as a rare cause of central skull base osteomyelitis.

Jalava-Karvinen P, Nyman M, Gardberg M, Harju I, Hohenthal U, Oksi J - Med Mycol Case Rep (2016)

Bottom Line: We report a case of Scedosporium apiospermum mold causing ear infection, central skull base osteomyelitis and finally, occlusion of carotid artery in a 48-year-old diabetic man.The exact diagnosis was established and the severity of the disease understood several months after the onset of symptoms.Despite of appropriate antifungal therapy, and repeated surgical and otological procedures, the infection progressed to fatal cerebral infarction.

View Article: PubMed Central - PubMed

Affiliation: Department of Infectious Diseases, Division of Medicine, Turku University Hospital, Turku, Finland; Faculty of Medicine, Turku University, Turku, Finland.

ABSTRACT
We report a case of Scedosporium apiospermum mold causing ear infection, central skull base osteomyelitis and finally, occlusion of carotid artery in a 48-year-old diabetic man. The exact diagnosis was established and the severity of the disease understood several months after the onset of symptoms. Despite of appropriate antifungal therapy, and repeated surgical and otological procedures, the infection progressed to fatal cerebral infarction.

No MeSH data available.


Related in: MedlinePlus

Photomicrograph of the ICA, PAS staining. Fungal hyphae (arrow) are seen among arterial wall smooth muscle cells and necrotic debris.
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f0010: Photomicrograph of the ICA, PAS staining. Fungal hyphae (arrow) are seen among arterial wall smooth muscle cells and necrotic debris.

Mentions: On day 207, the patient contacted the emergency because of headache and dizziness. On examination, he still had abducens nerve palsy. CSF analysis revealed 2021×106/l leukocytes, indicating meningitis. Bacterial and fungal cultures and PCRs remained negative. Next day, the patient's condition collapsed, he was unconscious, rejecting pain with extension. MRI revealed an occlusion of the ICA at the level of MCA bifurcation. There was a suspected rupture of proximal right MCA with intracerebral hematoma and a large brain infarct of the corresponding MCA area. ICZ (received for compassionate use) was instituted but continued only two days before the patient died on day 212. Postmortem findings were consistent with previous investigations: skull base and vessel wall of the ICA were affected by fungal infection as seen also on histological sections (Fig. 2). S. apiospermum was cultured from both structures but not from the brain tissue. Massive cerebral infarction had led to brain herniation and to the death of the patient.


Scedosporium apiospermum as a rare cause of central skull base osteomyelitis.

Jalava-Karvinen P, Nyman M, Gardberg M, Harju I, Hohenthal U, Oksi J - Med Mycol Case Rep (2016)

Photomicrograph of the ICA, PAS staining. Fungal hyphae (arrow) are seen among arterial wall smooth muscle cells and necrotic debris.
© Copyright Policy - CC BY-NC-ND
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4834721&req=5

f0010: Photomicrograph of the ICA, PAS staining. Fungal hyphae (arrow) are seen among arterial wall smooth muscle cells and necrotic debris.
Mentions: On day 207, the patient contacted the emergency because of headache and dizziness. On examination, he still had abducens nerve palsy. CSF analysis revealed 2021×106/l leukocytes, indicating meningitis. Bacterial and fungal cultures and PCRs remained negative. Next day, the patient's condition collapsed, he was unconscious, rejecting pain with extension. MRI revealed an occlusion of the ICA at the level of MCA bifurcation. There was a suspected rupture of proximal right MCA with intracerebral hematoma and a large brain infarct of the corresponding MCA area. ICZ (received for compassionate use) was instituted but continued only two days before the patient died on day 212. Postmortem findings were consistent with previous investigations: skull base and vessel wall of the ICA were affected by fungal infection as seen also on histological sections (Fig. 2). S. apiospermum was cultured from both structures but not from the brain tissue. Massive cerebral infarction had led to brain herniation and to the death of the patient.

Bottom Line: We report a case of Scedosporium apiospermum mold causing ear infection, central skull base osteomyelitis and finally, occlusion of carotid artery in a 48-year-old diabetic man.The exact diagnosis was established and the severity of the disease understood several months after the onset of symptoms.Despite of appropriate antifungal therapy, and repeated surgical and otological procedures, the infection progressed to fatal cerebral infarction.

View Article: PubMed Central - PubMed

Affiliation: Department of Infectious Diseases, Division of Medicine, Turku University Hospital, Turku, Finland; Faculty of Medicine, Turku University, Turku, Finland.

ABSTRACT
We report a case of Scedosporium apiospermum mold causing ear infection, central skull base osteomyelitis and finally, occlusion of carotid artery in a 48-year-old diabetic man. The exact diagnosis was established and the severity of the disease understood several months after the onset of symptoms. Despite of appropriate antifungal therapy, and repeated surgical and otological procedures, the infection progressed to fatal cerebral infarction.

No MeSH data available.


Related in: MedlinePlus