Cerebral Blastomycosis in a Tunisian Woman

Abstract

Background: Blastomycosis is a non-opportunistic fungal infection caused by Blastomyces dermatitides. Infection of the central nervous system is an uncommon localization of this disease occurring only in 5-10% of cases. Case report: We report a new case of a 57-year-old woman, who was admitted in the neurosurgical department for severe headache, vomiting, and a visual disturbance. Physical and biological investigations were normal. Magnetic resonance imaging led to find an intracranial and extracranial expansive processes, measuring 42 mm in length. The microscopic examination revealed a chronic granulomatous inflammation, associating epithelioid and multinucleated giant cells containing thick-walled budding yeast-like forms. Grocott-Gomori methenamine-silver staining led to confirm its fungal nature, and it was precisely Blastomyces dermatitidis. The postoperative course was complicated by cerebral edema associated with an important cerebral hemorrhage. The patient died 11 days after the surgery. Conclusion: Cerebral involvement remains a serious but uncommon manifestation of blastomycosis. It should be suspected in front of a granulomatous inflammation with the presence of spore on the pathological examination. The delay in diagnosis has been reported to play a significant role in the high mortality rate.