A fungal infection of the brain of a 55-year-old male patient is reported. The lesion and involved fungus were located exclusively in the right medial temporo-parietal region. The patient was successfully treated with surgical resection of the lesion and antifungal chemotherapy. Few pathogenic dematiaceous fungi exhibit neurotropism and can cause primary infection in the central nervous system (CNS). The etiological agent is described as a Nodulisporium species. To date Nodulisporium has never been reported as an agent of CNS infection in humans.
CASE REPORTA 55-year-old male patient was admitted to the neurosurgery facility of Nizam's Institute of Medical Sciences (NIMS), Hyderabad, Andhra Pradesh, India, with an admitting diagnosis of right choroidal meningioma.Two months prior to admittance to NIMS, the patient experienced rapid deterioration of vision in the right eye along with associated numbness in the right half of the face. For 1 year prior to admittance he had also experienced difficulty in chewing food and intermittent episodes of transient loss of consciousness associated with weakness on the right side, mainly involving the limbs. The recovery time from such episodes was about 1 to 2 h. There was no history of generalized tonic or clonic seizures. He did not have a history of hypertension or diabetes and was not on any medication.A computerized tomogram (CT) of the brain was performed by the referring hospital ( Fig. 1). CT sections 5 mm thick were obtained in the posterior fossa, and CT sections 10 mm thick were obtained thereafter, both before and after administration of intravenous contrast (ionic contrast [40 ml of 76% Uro Video; Bracco]). The scan revealed a large, irregularly shaped, slightly hyperdense, densely enhancing lesion in the right medial temporo-parietal region of about 44.3 by 33.2 mm. It showed a large, irregular, hypodense white matter with surrounding edema. There was a shift in the midline structures to the left. The ventricular system and sulcal cerebrospinal fluid spaces were effaced more on the right. The overall impression was of a sphenoid meningioma in the right medial temporoparietal region with cerebral edema. With these clinical details, the patient was referred to NIMS for further management.The patient was conscious and coherent. There were no signs of anemia, clubbing, or palpitation. His pulse and respiratory rate were within the normal range. There was no lymphadenopathy or organomegaly.The right eye showed exophthalmos, with no pupillary light reaction and primary optic atrophy on fundus examination. The left eye was normal. Paresis of the right fifth and sixth cranial nerves was present. There was loss of motor and sensory components of the fifth cranial nerve. There were no other sensory or motor deficits.The peripheral blood picture and biochemistry were within normal limits. Hemoglobin was 13.5 g%, packed cell volume was 39%, and total leukocyte counts and differential counts were within normal range. The test of anti-human immunodeficiency virus antibodies w...