Intracranial Candida parapsilosis infection occurring 2 years after burr-hole drainage for chronic subdural hematoma: a case report.

Abstract

Background: Chronic subdural hematoma (CSDH) is a common condition affecting patients undergoing neurosurgical treatment for which burr-hole drainage remains the standard treatment. Postoperative fungal infections following this procedure are extremely rare, but can lead to severe consequences.

Case description: A 66-year-old male with a history of hypertension and schizophrenia underwent bilateral burr-hole drainage for bilateral frontotemporoparietal CSDH at another hospital 2 years prior to presentation. In the intervening years following this procedure, he experienced recurrent headaches, developed involuntary tongue protrusion and limb shaking, and suffered one episode of seizure 10 days before admission. Imaging suggested recurrence and possible organization of the bilateral CSDH. Bilateral craniotomy for hematoma evacuation was performed. Intraoperative examination revealed the organization and thickening of the subdural hematoma membrane, with a maximum thickness of approximately 1 cm. Postoperative pathological examination unexpectedly revealed structures suggestive of fungal hyphae. Subsequent cerebrospinal fluid culture confirmed the presence of Candida parapsilosis infection, establishing the definitive etiological diagnosis. The patient was successfully cured through surgical evacuation, antifungal therapy consisting of sequential voriconazole and fluconazole treatment, temporary lumbar drainage, and comprehensive management of complications, although the course of hospitalization was further complicated by intestinal obstruction, pneumonia, and bacteremia.

Conclusion: This report describes a rare case of intracranial C. parapsilosis infection occurring 2 years after burr-hole drainage for the management of a CSDH. This case highlights the diagnostic challenges associated with delayed postoperative fungal infections and emphasizes the importance of pathological examination when encountering atypical surgical findings. A multidisciplinary approach combining aggressive surgical debridement with targeted antifungal therapy is crucial for achieving a favorable outcome.