Epidural abscess caused by Schizophyllum commune: A rare case of rhinogenic cranial complication by a filamentous basidiomycete

Abstract

Central nervous system (CNS) infections due to filamentous basidiomycetes are extremely rare. We encountered a case of epidural abscess due to Schizophyllum commune that extended from sinusitis. A 53-year-old Japanese man presented at our hospital with a headache. Computed tomography (CT) of the cranium and sinuses showed ethmoid and sphenoid sinusitis with no intracranial abnormalities. The patient was diagnosed with acute sinusitis and underwent antibiotic treatment. However, the symptoms deteriorated, and the patient came to our hospital again with consciousness disturbance. CT scan of the cranium and sinuses showed no improvement of sinusitis after antibiotic therapy and an epidural abscess emerged in the middle cranial fossa. Therefore, emergency craniotomy and endoscopic sinus fenestration were performed. Filamentous fungal elements were observed in both rhinorrhoea and epidural abscess. The symptoms improved after the operation and administration of liposomal amphotericin B. The clinical isolate was identified as S. commune by a molecular-based method. To our knowledge, this is the first report of epidural abscess due to this fungus. Although rare, clinicians should be aware that S. commune could be a causative agent of CNS infections.

A Rare Case of Bronchiectasis with Mucoid Impaction Caused by Schizophyllum commune in an Immunocompetent Woman in South Korea

“…The rate of human infections caused by S. commune has been increasing recently [3]. Several cases have been reported in immunocompromised and immunocompetent patients [4][5][6][7][8][9][10][11][12][13][14][15][16]. We reviewed published reports of S. commune-induced invasive infections in immunocompetent patients (Table 1).…”

“…We reviewed published reports of S. commune-induced invasive infections in immunocompetent patients (Table 1). Even in immunocompetent patients, S. commune induced serious in ammation such as pneumonia or epidural abscess [4,5]. For example, in the US, an immunocompetent 58-year-old man died of pneumonia and brain abscess caused by S. commune [4].…”

Case report: Diagnosis and treatment of delayed epidural pyogenic abscess after brain tumor operation: a report of 5 cases and review of the literature

“…Earlier literature reported that aerobic Gram-negative bacteria accounted for less than 10% of isolates, while in Hlavin et al's report, the aerobic Gram-negative bacteria were cultured in 52% of patients ( 7 ). There have also been reports of fungal cultures in the literature ( 15 , 16 ), and mixed bacterial infections are common as well. Among our 5 patients, 3 cases had positive bacterial cultures, with 1 case for Pseudomonas aeruginosa and 2 cases for Staphylococci .…”

Pneumonia due toSchizophyllum communein a Patient with Acute Myeloid Leukemia: Case Report and Literature Review

“…We reviewed global literatures to identify clinical presentation, underling disease of patients, and treatment for invasive human diseases caused by S. commune , and categorized those cases according to the underlying conditions of host ( Table 2 ) [ 4 5 6 7 8 9 10 15 16 17 18 19 20 ]. We excluded non-invasive cases such as sinusitis without evidence of mucosal invasion in immunocompetent host.…”

“…We excluded non-invasive cases such as sinusitis without evidence of mucosal invasion in immunocompetent host. There were four cases of S. commune invasive infection developed in immunocompetent host which were characterize to involve sino-orbital structure or brain [ 8 16 17 18 ]. Although the four patients were classified as immunocompetent, one was an air conditioning installer which might be a risk of fungal infection by route of inhalation.…”