An elusive diagnosis: Scedosporium apiospermum infection after near-drowning

Abstract

A 51-year-old male was admitted in our institute following an episode of near-drowning. He later developed ventriculitis and cerebral ring-enhancing lesions. He died following a subarachnoid hemorrhage due to rupture of a mycotic aneurysm involving the right fetal posterior cerebral artery. Scedosporium apiospermum was isolated from the cerebrospinal fluid. Central nervous system invasion by S apiospermum may present insidiously in near-drowning patients and, therefore, requires a high index of suspicion. In cases with the characteristic cerebral ring-enhancing lesions and concomitant ventriculitis, treatment should be instituted while awaiting fungal culture. With this article we intend to alert neurologists, intensivists, and physicians to this near fatal infection, as early identification and prompt treatment with voriconazole may be life saving.

Keywords: Fungal meningitis; Pseudallescheria boydii; Scedosporium apiospermum; near-drowning.

Figure 1

MRI coronal postcontrast T1 sequence shows ringenhancing lesion in the right anterior temporal pole and left parietooccipital region (black arrows); there is enhancement involving the right frontal horn, suggesting ventriculitis

Figure 2

Computerized tomography (CT) shows diffuse subarachnoid hemorrhage (SAH) involving the basal cisterns, prepontine cistern (white arrow), left sylvian cistern, bilateral occipital horns (white arrow), third and fourth ventricle along with mild hydrocephalus

Figure 3

Three-dimensional reconstructed CT angiogram shows fusiform aneurysm with a saccular projection arising from the middle of right fetal posterior cerebral artery (PCA) and directed posterosupero- laterally (white arrow)