A Rare Case of Brain Abscesses Caused by Acremonium Species

Abstract

Acremonium species are saprophytic fungi that are rarely pathogenic in humans. According to several reports, Acremonium species can cause various diseases, ranging from superficial infections after traumatic inoculation in immunocompetent individuals to invasive infections in the immunocompromised. To the best of our knowledge, this is the first case report of brain abscess in an 18-year-old male caused by Acremonium species in Pakistan. A combination of intravenous amphotericin B and oral voriconazole was administered to the patient, which resulted in marked clinical improvement. However, the recurrence of fungiwas observed after three months of completion of the antifungal course. The purpose of this report is to alert clinicians regarding this pathogen and its ability to cause systemic disease.

Keywords: acremonium; amphotericin; brain abscess; fungal abscess; recurrence; voriconazole.

Figure 1. Magnetic resonance images of the brain (without contrast) showing arrows pointing to multifocal, lobulated, ring-enhancing lesions in both cerebral hemispheres surrounded with vasogenic edema (A, B)

Figure 2. Diffusion-weighted magnetic resonance images of the brain with arrows pointing out multiple lesions with restricted diffusion in both cerebral hemispheres, including the basal ganglia, left thalamus, left cerebral peduncle, and right frontal lobe, surrounded with vasogenic edema (A, B)

Figure 3. Post-craniotomy computed tomography scan of the brain showing partial evacuation of the right frontal lobe lesion and multifocal hypodense lesions as shown by arrows in both cerebral hemispheres