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Arora K, Dawkins RL, Bauer DF, et al. Intracranial blastomycotic abscess mimicking malignant brain neoplasm: Successful treatment with voriconazole and surgery. Surg Neurol Int. 2015;6:174doi: 10.4103/2152-7806.170025.
Arora, K., Dawkins, R. L., Bauer, D. F., Palmer, C. A., Hackney, J. R., & Markert, J. M. (2015). Intracranial blastomycotic abscess mimicking malignant brain neoplasm: Successful treatment with voriconazole and surgery. Surgical neurology international, 6174. https://doi.org/10.4103/2152-7806.170025
Arora, Kanika, et al. "Intracranial blastomycotic abscess mimicking malignant brain neoplasm: Successful treatment with voriconazole and surgery." Surgical neurology international vol. 6 (2015): 174. doi: https://doi.org/10.4103/2152-7806.170025
Arora K, Dawkins RL, Bauer DF, Palmer CA, Hackney JR, Markert JM. Intracranial blastomycotic abscess mimicking malignant brain neoplasm: Successful treatment with voriconazole and surgery. Surg Neurol Int. 2015 Nov 20;6:174. doi: 10.4103/2152-7806.170025. eCollection 2015. PMID: 26673672; PMCID: PMC4665129.
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Surg Neurol Int. 2015 Nov 20;6:174. doi: 10.4103/2152-7806.170025. eCollection 2015.

Intracranial blastomycotic abscess mimicking malignant brain neoplasm: Successful treatment with voriconazole and surgery.

Surgical neurology international

Kanika Arora, Ross L Dawkins, David F Bauer, Cheryl A Palmer, James R Hackney, James M Markert

Affiliations

  1. Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama, USA.
  2. Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama, USA.
  3. Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA.
  4. Department of Pathology, University of Utah, Salt Lake City, Utah, USA.
  5. Department of Pathology, University of Alabama at Birmingham, Birmingham, Alabama, USA.

PMID: 26673672 PMCID: PMC4665129 DOI: 10.4103/2152-7806.170025

Abstract

BACKGROUND: Cerebral blastomycosis is a rarely reported disease, and in the absence of associated, underlying systemic infection, poses a great diagnostic difficulty. Magnetic resonance imaging can sometimes provide equivocal information when trying to pinpoint a diagnosis. Classically, cerebral blastomycosis has been treated with amphotericin B. Voriconazole is a newer triazole antifungal with potential as a follow-up treatment of blastomycosis of the central nervous system after initial therapy with amphotericin B.

CASE DESCRIPTION: We describe one such case of a cerebral blastomycotic abscess, presenting in the absence of any systemic disease, which was initially thought to be a neoplasm. It was successfully treated by surgical resection followed by sequential amphotericin B and voriconazole. The patient did well with voriconazole therapy and was followed for voriconazole tolerance with liver function tests, which continued to be stable at 8 months past the initiation of therapy. At 12 months postoperatively, the patient was doing well and showed gradual improvement in a visual field cut, with no sign of recurrent infection.

CONCLUSIONS: Isolated cerebral blastomycosis can present a diagnostic challenge. In the absence of systemic infection, surgical resection followed by antifungal therapy is a logical treatment plan.

Keywords: Blastomycotic abscess; cerebral blastomycosis; voriconazole

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