Destini Smith1, Joshua Butler2, Khurram Bashir3
1University of Alabama at Birmingham, 2University of Alabama Birmingham, 3Univ Alabama Birmingham Dept of Neuro
Background:
Blastomycosis, caused by the fungus Blastomyces dermatitidis, is a rare infection endemic to the Great Lakes, Mississippi, and Ohio River valleys. While commonly presenting as a pulmonary infection, it can lead to severe central nervous system (CNS) complications like meningitis and encephalopathy. Previous cases have primarily occurred in immunocompromised patients. This case report highlights an atypical instance of Blastomyces dermatitidis meningitis and ventriculitis in an immune-competent patient.
Results:
A previously healthy 50-year-old female truck driver was discovered unresponsive in her 18-wheeler. She was admitted to a local hospital with encephalitis and a subacute left basal ganglia infarct and subsequently transferred to the University of Alabama at Birmingham Medical Center for neurosurgical intervention due to elevated intracranial pressure. Suspecting an infectious etiology, blood, urine, and CSF cultures were obtained, but these did not reveal a source. Initial broad-spectrum antibiotic therapy yielded no clinical improvement. Given her immunocompetent state, a fungal infection was not initially considered, and antifungal treatment was not initiated. However, CSF cytopathology analysis eventually revealed numerous yeast and hyphae with fungal culture resulting positive for Blastomyces dermatitidis. Initiation of antifungal treatment led to a significant improvement in her condition. A six-week course of amphotericin B was followed by long-term isavuconazonium treatment.
Conclusions:
This exceptional case underlies the significance of considering fungal pathogens in the evaluation of isolated CNS infections, even in immunocompetent individuals, when a bacterial source is not readily identified. Although such infections are usually associated with immunocompromised patients, this case emphasizes the possibility of severe fungal infections in individuals without apparent immune deficiencies. Heightened clinical awareness and timely diagnostic measures are crucial for managing such atypical cases and improving patient outcomes.