Scedosporium apiospermum-induced brain abscess leading to rapid mortality in an immunocompetent adult male from Uttarakhand, India.

Abstract

Background and purpose: Scedosporium apiospermum, a soil-dwelling fungus, is typically associated with localized infections, such as skin infections and osteomyelitis. However, it can also cause invasive central nervous system infections, including brain abscesses, particularly in immunocompromised individuals. Such infections are rare in immunocompetent individuals and often occur following trauma or environmental exposure. This report aimed to present a case of a fatal S. apiospermum brain abscess in an immunocompetent adult male, highlighting diagnostic and management challenges.

Case presentation: A 48-year-old immunocompetent male presented with a three-day history of persistent holo-cranial headache and left-sided weakness. Twenty days earlier, the patient had fallen into a sewer, likely exposing him to fungal pathogens. Initial imaging revealed a large right frontal intracranial lesion. Surgical resection of the abscess was performed, and antifungal therapy with voriconazole was initiated. Intraoperative findings revealed a thick, non-vascular abscess capsule containing yellow pus. Postoperative KOH mount confirmed fungal elements (hyaline septate hyphae). Despite aggressive management in the intensive care unit, including antifungal therapy, antibiotics, and supportive care, the patient developed septic shock and succumbed to cardiac arrest within 48 h of surgery.

Conclusion: This case underscores the rapid progression and severity of S. apiospermum infections in immunocompetent individuals, even with early surgical and medical intervention. It emphasizes the need for heightened clinical suspicion in cases involving trauma with potential environmental exposure. Prompt diagnosis, effective antifungal therapy, and multidisciplinary management are essential to improve outcomes in such cases.