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Scedosporium Cerebral Abscesses After Extra-Corporeal Membrane Oxygenation

  • Hosam Al-Jehani (a1), Marie-Christine Guiot (a2), Carlos Torres (a3) and Judith Marcoux (a1) (a4)

Abstract

Background:

Scedosporial infections are usually encountered in the immunocompromised patients. However, they are now emerging in the immunocompetent population and have an affinity for the central nervous system. They represent a therapeutic challenge, since they are highly resistant to most antifungal medications.

Methods:

We report the case of an immunocompetent patient with multiple cerebral abscesses secondary to Scedosporium apiospermum following extracorporeal membrane oxygenation (ECMO) and review the literature about this challenging cerebral infection.

Results:

A previously healthy 33-year-old male admitted to the hospital for a community-acquired pneumonia requiring ECMO subsequently developed multiple cerebral abscesses. He was empirically treated with caspofungin, which was changed to voriconazole once surgical aspiration revealed Scedosporium apiospermum. Despite multiple aspirations, decompressive craniectomy to alleviate intracranial pressure, and an appropriate antifungal agent, the patient did not survive this aggressive infection.

Conclusion:

Brain abscesses with Scedosporium apiospermum present a therapeutic challenge. High clinical suspicion leading to early appropriate antifungal therapy and combined surgical interventions might improve the prognosis.

RÉSUMÉ: Contexte:

Les infections à Scédosporium se rencontrent habituellement chez des patients immunocompromis. Cependant, on les rencontre maintenant dans la population immunocompétente et ells ont une affinité pour le système nerveux central. Leur traitement constitue un défi, étant donné qu’elles sont très résistantes à la plupart des medicaments antifongiques.

Méthodes:

Nous décrivons le cas d’un patient immunocompétent qui a présenté de multiples abcès cérébraux dus à Scedosporium apiospermum après assistance respiratoire extracorporelle (AREC) et nous revoyons la littérature sur cette infection cérébrale dont la prise en charge présente un défi.

Résultats:

Un homme de 33 ans sans antécédent pathologique a été hospitalisé pour une pneumonie extrahospitalière qui a nécessité une AREC. Il a par la suite présenté de multiples abcès cérébraux pour lesquels il a été traité de façon empirique par la caspofungine, puis par le voriconazole après que l’aspiration chirurgicale ait révélé la présence de Scédosporium apiospermum. Le patient est décédé malgré de multiples aspirations, une craniectomie décompressive pour diminuer la pression intracrânienne et l’administration d’un antifongique approprié.

Conclusion:

Les abcès cérébraux à Scédosporium apiospermum présentent un défi thérapeutique. Un haut degré de soupçon clinique motivant un traitement précoce par un antifongique approprié, combiné à la chirurgie, pourraient en améliorer le pronostic.

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Copyright

Corresponding author

Neurosurgery Department, McGill University, Montreal General Hospital, 1650 Cedar Avenue, Room: L7-524, Montreal, Quebec, H3G 1A4, Canada.

References

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