Fatal mycotic aneurysms due to Scedosporium and Pseudallescheria infection

Abstract

Angioinvasive complications of Scedosporium infections are rare. We report two cases of mycotic aneurysm, following apparent localized infection, due to Scedosporium apiospermum and Pseudallescheria boydii. The thoracoabdominal aorta was affected in one patient, and cerebral vessels were affected in the other. Despite voriconazole therapy and surgical resection, the patients died. Previously reported cases are reviewed.

Fig. 1.

(a) MRI (T2 weighted images) of patient A, demonstrating osteomyelitis and paravertebral abscess at lumbar vertebrae 4 (LV4). Anterior and contiguous to this, at the level of LV2, is a hypodense area consistent with inflammatory aortitis (arrow). (b) CT reconstruction of the aorta of patient A, demonstrating the funnel-shaped enlarging aneurysm.

Fig. 2.

Histopathological staining with PAS demonstrates a large-sized artery with the vessel wall showing intimal fibrosis, fragmentation of elastic lamina, and multifocal granulomatous inflammation containing several foreign body-type giant cells. Focal aggregates of PAS-positive fungal elements with branching septate hyphae and yeastlike structures are seen at the center of the granuloma. The specimen was obtained from patient A.