Candida albicans cerebral granulomas associated with a nonfunctional cerebrospinal fluid shunt: case report.

Abstract:

OBJECTIVE AND IMPORTANCE:We report an unusual case of basal ganglia granulomas caused by Candida albicans that surrounded the proximal segment of a nonfunctional cerebrospinal fluid shunt in a previously healthy patient. CLINICAL PRESENTATION:A 22-year-old woman had undergone ventriculoatrial cerebrospinal fluid shunt placement for posttraumatic hydrocephalus 3 years previously. One year later, a shunt revision was followed by wound dehiscence with local infection at the neck level. She received oral administration of antibiotics for 3 months until the wound closed. Twelve weeks before admission, the patient experienced pulmonary emboli. She received anticoagulants, and the distal segment of the shunt was removed. Five weeks after shunt removal, she presented with headache and left-sided hemiplegia caused by right basal ganglia inflammatory masses. INTERVENTION:A stereotactic brain biopsy was performed, and the shunt remnants were removed. Microscopically, the lesions were acutely and chronically inflamed. C. albicans grew in tissue and in shunt hardware cultures. The patient was treated with 1.1 g of intravenously administered amphotericin B and orally administered ketoconazole; she recovered completely. CONCLUSION:C. albicans brain granulomas occur rarely in immunocompetent patients. Despite the large size of the lesions and severe brain edema, the absence of an underlying disease contributed to complete resolution after shunt removal and antifungal therapy.

journal_name

Neurosurgery

journal_title

Neurosurgery

authors

Soto-Hernández JL,Ramírez-Crescencio MA,Moreno Estrada VM,del Valle Robles R

doi

10.1097/00006123-200010000-00037

keywords:

subject

Has Abstract

pub_date

2000-10-01 00:00:00

pages

973-6; discussion 976-7

issue

4

eissn

0148-396X

issn

1524-4040

journal_volume

47

pub_type

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