Citation

Cervera-Hernandez ME, Szymczak W, Puius YA, Shuter J. Am. J. Med. 2021; ePub(ePub): ePub.

Copyright

(Copyright © 2021, Elsevier Publishing)

DOI

10.1016/j.amjmed.2021.04.039

PMID

unavailable

Abstract

A 35-year-old man with a history of substance abuse was taken to the hospital after being rescued from a freshwater river where he had a near-drowning experience. He was treated in the ICU for aspiration pneumonia and had a favorable initial clinical course. On day 20 of the hospital stay, worsening cough and new left upper and lower extremity weakness were noted. A CT showed bilateral lung cavitation and nodularity (Figure A, B), and an MRI revealed multiple lesions within the brain and cervical cord (Figure C, D). Laboratory examination was notable for white blood cell count of 65.7 × 103/µL, platelets of 783 × 103/µL, CRP of 104 mg/L, and a serum (1,3)-ß-D-glucan (BDG) of 344 pg/mL. Blood and cerebrospinal fluid cultures were negative for bacteria, fungi, and mycobacteria. However, cultures of expectorated sputum were positive for Lomentospora prolificans and Scedosporium apiospermum (Figure E-H), and later confirmed by DNA sequencing. The patient was treated with a combination of intravenous voriconazole, micafungin, and dexamethasone. Interval brain and spine MRI on day 25 after initiation of antifungals revealed a reduction in the size of the lesions, and the neurological exam showed improvement. He was discharged home on long-term oral voriconazole and terbinafine. Serum BDG became negative by day 57 of therapy. At nine months of follow-up, the patient's upper extremity weakness continues to improve, and repeat MRI shows resolution of the brain lesions and reduction in the size of the cervical cord lesion...

Language: en

Keywords

abscess; central nervous system; Lomentospora prolificans; near-drowning; Scedosporium apiospermum