Cerebral Scedosporium apiospermum infection presenting with intestinal manifestations

Abstract

We present a case of cerebral Scedosporium apiospermum infection presenting with intestinal manifestations in a 64-year-old male patient on immunosuppression for orthotopic liver transplantation. At admission, the patient's chief complaint was chronic watery diarrhea and he was found to have colonic ulcers on endoscopy. His hospital course was complicated by a tonic-clonic seizure caused by a left frontal brain abscess, with the causative agent being identified by culture. He was treated with lobectomy, high-dose intravenous voriconazole, and liposomal amphotericin with clinical, endoscopic, and histologic improvement. To our knowledge, S. apiospermum has not been previously described as a cause of colitis. The septate branching appearance of the Scedosporium species is similar to the more common Aspergillus species. This case of gastrointestinal Scedosporium brings into question previously reported cases of isolated gastrointestinal aspergillosis diagnosed by histopathology. Clinical suspicion for S. apiospermum must be maintained in immunosuppressed patients presenting with neurologic and gastrointestinal symptoms.

Prognostic factors in 264 adults with invasiveScedosporiumspp. andLomentospora prolificansinfection reported in the literature and FungiScope®

“…; Gelabert-Gonz alez et al 2010;Kimura et al 2010;Morio et al 2010;O'Hearn et al 2010;Ortmann et al 2010;Sarva et al 2010;Sireesha et al 2010;Spanevello et al 2010; Fern andez Guerrero et al 2011; Gottesman-Yekutieli et al 2011; Lackner et al 2011; Luijk et al 2011; Makino et al 2011; Nakamura et al 2011; Nguyen and Raychaudhuri 2011; Ohashi et al 2011; Ong et al 2011; Rivier et al 2011; Ruinemans et al 2011; Sol e 2011; Stur-Hofmann et al 2011; Takeuchi et al 2011;Tammer et al 2011;Bose et al 2012;Ceccarelli et al 2012;Cetrulo et al 2012;Harrison et al 2012;Mays et al 2012;Yoneda et al 2012;Allen et al 2013;Ergin et al 2013;Fadzillah et al 2013;Henao-Mart ınez et al 2013;Holmes et al 2013;Husain et al 2013;Kubisiak- Rzepczyk et al 2013;Larbcharoensub et al 2013;Lin et al 2013;Nakamura et al 2013;Sayah et al 2013; Slone et al 2013; Wilson and Kennedy 2013; Yu et al…”

Fungal infection of the colon

“…Both pneumocystosis and scedosporiosis are known only from one case report. 51 , 52 Excluding oropharyngeal candidiasis, the colon is the third most common gastrointestinal organ to be involved in candidiasis following the esophagus and stomach. The colon is involved in 20% of gastrointestinal candidiasis.…”

“… 37 , 38 There have also been case reports of colonic pneumocystosis and scedosporiosis in immunocompromised patients with AIDS and post-liver transplantation, respectively. 51 , 52 In colonic paracoccidioidomycosis and histoplasmosis, there are no necessary risk factors present. 20 , 21 , 45 – 50 As shown in Table 7 , males predominate in nearly all fungal infections, except for colonic candidiasis, aspergillosis, and paracoccidioidomycosis.…”

“… 36 – 38 For example, a case of colonic pneumocystosis presented with fever and diarrhea, 51 while one with colonic scedosporiosis presented with diarrhea and abdominal pain. 52 …”

“… 21 , 45 – 50 , 73 Colonic scedosporiosis, likewise, presents with ulcer. 52 On the contrary, colonic cryptococcosis presents with a mass or polyp as the most common pathologic finding, while colonic cryptococcosis may also present with atypical pathologic findings, including rectal abscess or stricture. 26 – 35 Another colonic infection that can present with a mass or polyp is histoplasmosis.…”