Successful Treatment of Cerebral Blastomycosis with Voriconazole

SUMMARY Blastomycosis is endemic in regions of North America that border the Great Lakes and the St. Lawrence River, as well as in the Mississippi River and Ohio River basins. Men are affected more often than women and children because men are more likely to participate in activities that put them at risk for exposure to Blastomyces dermatitidis. Human infection occurs when soil containing microfoci of mycelia is disturbed and airborne conidia are inhaled. If natural defenses in the alveoli fail to contain the infection, lymphohematogenous dissemination ensues. Normal host responses generate a characteristic pyogranulomatous reaction. The most common sites of clinical disease are the lung and skin; osseous, genitourinary, and central nervous system manifestations follow in decreasing order of frequency. Blastomycosis is one of the great mimickers in medicine; verrucous cutaneous blastomycosis resembles malignancy, and mass-like lung opacities due to B. dermatitidis often are confused with cancer. Blastomycosis may be clinically indistinguishable from tuberculosis. Diagnosis is based on culture and direct visualization of round, multinucleated yeast forms that produce daughter cells from a single broad-based bud. Although a long course of amphotericin B is usually curative, itraconazole is also highly effective and is the mainstay of therapy for most patients with blastomycosis.

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“…Anecdotal reports support the use of voriconazole as an alternative agent, particularly in the setting of CNS blastomycosis (7,13,64,73,93).…”

Section: Treatment Treatment Optionsmentioning

confidence: 99%

Clinical and Laboratory Update on Blastomycosis

2010

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“…Recently, other cases have been also reported in Canada, Europe, Mexico, Central America, and Africa [1][2][3].…”

Section: Discussionmentioning

confidence: 99%

“…It presents, commonly, as a chronic meningitis, subdural focal leptomeningeal abscess, or intraparenchymal abscess. The latter two pathological entities are encompassed under the rubric of cerebral blastomycoma [1]. In patients with intracranial locations, may be single and multiple lesions can be seen, and the cerebellum is frequently involved [2].…”

Section: Discussionmentioning

confidence: 99%

“…The 2-hydroxystilbamidine had an acceptable cure rates in patients in whom the blastomycosis has been slowly progressive and of limited extent, confined to the lung and the skin. Ketoconazole was also recently used in few selected patients with some cures [1,[5][6][7].…”

Section: Discussionmentioning

confidence: 99%

“…Blastomycosis is different by its eventual occurrence in a normal immune state patient. Originally described by Gilchristl as a cutaneous infection, it is now accepted as a systemic disease with many classic and unusual locations [1][2][3].…”

Section: Introductionmentioning

confidence: 99%

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Cerebral Blastomycosis in a Tunisian Woman

Bdioui¹,

Abdessayed²,

Mhamdi³

et al. 2018

Am J Res Med Sci

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Background: Blastomycosis is a non-opportunistic fungal infection caused by Blastomyces dermatitides. Infection of the central nervous system is an uncommon localization of this disease occurring only in 5-10% of cases. Case report: We report a new case of a 57-year-old woman, who was admitted in the neurosurgical department for severe headache, vomiting, and a visual disturbance. Physical and biological investigations were normal. Magnetic resonance imaging led to find an intracranial and extracranial expansive processes, measuring 42 mm in length. The microscopic examination revealed a chronic granulomatous inflammation, associating epithelioid and multinucleated giant cells containing thick-walled budding yeast-like forms. Grocott-Gomori methenamine-silver staining led to confirm its fungal nature, and it was precisely Blastomyces dermatitidis. The postoperative course was complicated by cerebral edema associated with an important cerebral hemorrhage. The patient died 11 days after the surgery. Conclusion: Cerebral involvement remains a serious but uncommon manifestation of blastomycosis. It should be suspected in front of a granulomatous inflammation with the presence of spore on the pathological examination. The delay in diagnosis has been reported to play a significant role in the high mortality rate.

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Blastomycosis

Bradsher

Bariola²

2010

Essentials of Clinical Mycology

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Successful Treatment of Cerebral Blastomycosis with Voriconazole

Cited by 73 publications

References 12 publications

Clinical and Laboratory Update on Blastomycosis

Clinical and Laboratory Update on Blastomycosis

Cerebral Blastomycosis in a Tunisian Woman

Blastomycosis

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