Cerebral Blastomycosis in a Tunisian Woman

Ahlem Bdioui, N. Abdessayed, Nozha Mhamdi, Marwa Guerfela, A. B. Abdelkader, M. Mokni
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Abstract

Blastomycosis is a nonopportunistic fungal infection caused by Blastomyces dermatitidis. Infection of the central nervous system is an uncommon localization of this disease occurring only in 5-10% of cases. We report a new case of a 57-year-old woman, who was admitted in the neurosurgical department for severe headaches, vomiting, and a visual disturbance. Physical and biological investigations were normal. Magnetic resonance imaging leaded to find an intracranial and extracranial expansive process, measuring 42 mm in length. The microscopic examination revealed a chronic granulomatous inflammation, associating epitheloid and multinucleated giant cells containing thick walled budding yeast-like forms. Grocott-Gomori methenamine-silver (GMS) staining leaded to confirm its fungal nature and it was precisely, B. dermatitidis. The post-operative course was complicated by cerebral edema associated with an important cerebral hemorrhage. The patient died 11 days after the surgery. Cerebral involvement remains a serious but uncommon manifestation of Blastomycosis. It should be suspected in front of a granulomatous inflammation with the presence of spore, on the pathological examination. Delay in diagnosis has been reported to play a significant role in the high mortality rate.
一名突尼斯妇女的脑母菌病
芽生菌病是由皮炎芽生菌引起的非机会性真菌感染。中枢神经系统感染是一种罕见的局部性疾病,仅在5-10%的病例中发生。我们报告一位57岁的女性,因严重头痛、呕吐和视力障碍而住进神经外科。生理、生物学检查均正常。磁共振成像发现一个颅内和颅外扩张过程,长度为42毫米。镜下检查显示慢性肉芽肿性炎症,相关的上皮和多核巨细胞含有厚壁芽殖酵母样形态。grocottt - gomori甲基胺银(GMS)染色证实了其真菌性质,确切地说,是皮炎b。术后出现脑水肿伴重要脑出血。患者在手术后11天死亡。大脑受累仍然是一种严重但不常见的表现。在病理检查上,应怀疑前方有肉芽肿性炎症伴孢子存在。据报道,诊断延误是造成高死亡率的重要原因。
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