Multimodality imaging in cranial blastomycosis, a great mimicker: Case-based illustration with review of clinical and imaging findings

Kochar, Puneet; Lath, Chinar; Klein, Andrew P.; Ulmer, John L.

doi:10.4103/0971-3026.178360

Cited by 6 publications

(8 citation statements)

References 19 publications

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“…Despite the variability between intraparenchymal and leptomeningeal lesions, MRI provides better diagnostic utility given the various reports of CT-negative findings in patients with confirmed intracranial Blastomyces . 10 The diagnostic utility of other MRI modalities has also been explored in limited studies, notably MR spectroscopy, which has shown trehalose peaks consistent with the presence of other intracranial fungomas. 10 …”

Section: Discussionmentioning

confidence: 99%

“… 10 The diagnostic utility of other MRI modalities has also been explored in limited studies, notably MR spectroscopy, which has shown trehalose peaks consistent with the presence of other intracranial fungomas. 10 …”

Section: Discussionmentioning

confidence: 99%

“…In 2008, the Infectious Diseases Society of America issued guidelines for managing Blastomyces , including cases of systemic infiltration. 10 Itraconazole, fluconazole, and voriconazole were included equivocally in their recommendations, although, more recently, studies have demonstrated the utility of voriconazole over other formulations for CNS dissemination of fungal infections due to improved CNS penetration of the medication. 15 …”

Section: Discussionmentioning

confidence: 99%

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Disseminated blastomycosis with an intracranial fungoma in an immunocompetent patient: illustrative case

Shaffer

Johnson²,

Guglielmi³

et al. 2023

Journal of Neurosurgery: Case Lessons

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BACKGROUND Blastomyces dermatitidis is a fungus endemic to central and southern North America. While infection most commonly results in pneumonia, a small number of infections progress to systemic disease, which may include intracranial lesions. Progression to systemic disease is most common in immunocompromised patients, such as those with human immunodeficiency virus. OBSERVATIONS The authors present a 44-year-old immunocompetent male who presented following a tonic-clonic seizure. Initial workup revealed a 19-mm enhancing intracranial mass. There was avid uptake of fluorescein sodium, and an en bloc resection of the mass was performed. Histopathology revealed B. dermatitidis. Medical management included amphotericin B and azole therapy. Postoperative recovery was uneventful, and no focal neurological deficits were appreciated. LESSONS This case highlights the neurosurgical management of a rare intracranial fungal manifestation in an immunocompetent patient. A literature review was also performed to better understand the role of neurosurgery in fungal infections. There were limited cases of intracranial Blastomyces reported in immunocompetent patients, and neurosurgical management varied (no intervention, biopsy, resection) and was underreported. Too few cases are reported to suggest neurosurgical intervention for blastomycosis improves outcomes. Medical management was relatively standard with azole and amphotericin therapy.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Disseminated blastomycosis with an intracranial fungoma in an immunocompetent patient: illustrative case

Shaffer

Johnson²,

Guglielmi³

et al. 2023

Journal of Neurosurgery: Case Lessons

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show abstract

“…Grocott’s methenamine-silver-stained section of the same mass at ×400 magnification ( B ) with broad-based budding yeast cells. Image source is Kochar et al, 2016, used under a creative commons license (CC BY-NC-SA 3.0) [ 92 ].…”

Section: Figurementioning

confidence: 99%

Blastomycosis—Some Progress but Still Much to Learn

Pullen

Alpern

Bahr

2022

JoF

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Blastomycosis, caused by Blastomyces spp., is an endemic mycosis capable of causing significant disease throughout the body. Higher rates of infection are seen in the Mississippi and Ohio River valleys, the Great Lakes region of the United States and Canada, much of Africa, and, to a lesser extent, in India and the Middle East. Limited reporting inhibits our true understanding of the geographic distribution of blastomycosis. An estimated 50% of those infected remain asymptomatic. Of those who present with symptomatic disease, pulmonary involvement is most common, while the most common extrapulmonary sites are the skin, bones, genitourinary system, and central nervous system. Itraconazole is the standard therapy for mild–moderate disease. Data for other azoles are limited. Amphotericin is used for severe disease, and corticosteroids are occasionally used in severe disease, but evidence for this practice is limited. Despite increasing incidence and geographic reach in recent years, there are still significant knowledge gaps in our understanding of blastomycosis. Here, we provide an updated review of the epidemiology, clinical presentations, and diagnostic and therapeutic approaches for this infection. We also discuss areas needing further research.

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“…These lesions are commonly reported in neurotuberculosis. [8910] These lesions have also been described in nocardiosis,[11] cranial blastomycosis,[12] and NCC[13] as isolated case reports. Conglomerate RELs are best seen in MRI due to its better soft-tissue resolution and multiplanar capabilities.…”

Section: Introductionmentioning

confidence: 99%

Conglomerate ring-enhancing lesions are common in solitary neurocysticercosis and do not always suggest neurotuberculosis

Garg

Kaur

Sebastian

et al. 2019

Ann Indian Acad Neurol

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Background and Purpose:Differentiating between neurocysticercosis (NCC) and neurotuberculosis has serious therapeutic implications and this distinction relies heavily on neuroimaging. Few case reports discuss the conglomeration of ring-enhancing lesions (RELs) in patients with solitary NCC. The aim of our study is to describe the imaging findings of conglomerate RELs in a cohort of patients with solitary NCC, emphasizing the frequency of conglomeration.Materials and Methods:This retrospective study included 100 patients with solitary NCC. Two neuroradiologists analyzed contrast-enhanced computed tomography (CT) images regarding morphology, enhancement pattern, location, number of lesions, and degree of perilesional edema. The solitary lesions were classified as solitary discrete RELs (SD-RELs) when a well-defined lesion was seen and solitary conglomerate RELs (SC-RELs) when two or more ring lesions or ring/rings plus disc lesions were present contiguously. Follow-up CT scans were evaluated for the resolution of lesions and surrounding edema.Results:Out of 100 patients, 42 were SD-RELs and 58 were SC-RELs. No statistically significant difference was found between both groups in terms of age of presentation, clinical presentation, lesion size and location, and degree of perilesional edema. Larger lesions (>10 mm) were more likely to show scolex and were associated with greater degree of edema in both subgroups. During follow-up, 13 patients had new lesions (SD-RELs-5, SC-RELs-8). In SD-RELs, follow-up lesions were in the same location in four patients and new location in one; and in SC-RELs, lesions were in the same location in seven and in new location in one case.Conclusion:Conglomeration of RELs is a common finding in patients with solitary NCC.

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Multimodality imaging in cranial blastomycosis, a great mimicker: Case-based illustration with review of clinical and imaging findings

Cited by 6 publications

References 19 publications

Disseminated blastomycosis with an intracranial fungoma in an immunocompetent patient: illustrative case

Disseminated blastomycosis with an intracranial fungoma in an immunocompetent patient: illustrative case

Blastomycosis—Some Progress but Still Much to Learn

Conglomerate ring-enhancing lesions are common in solitary neurocysticercosis and do not always suggest neurotuberculosis

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