Journal of

Case Reports and Images in Medicine

 
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Case Report
 
Scedosporium brain abscess in an individual with Crohn's disease on chronic immunosuppression
Jean Liew1, Jia Luo1, Graeme Forrest2, Adam Obley3
1MD, Resident Physician, Department of Medicine, Oregon Health and Science University, Portland, Oregon, USA.
2MD, Associate Professor, Division of Infectious Diseases, Portland Veterans Affairs Medical Center, Portland, Oregon, USA.
3MD, Associate Professor, Division of General Internal Medicine, Portland Veterans Affairs Medical Center, Portland, Oregon, USA.

Article ID: 100025Z09JL2016
doi:10.5348/Z09-2016-25-CR-18

Address correspondence to:
Jean Liew
MD, Department of Medicine, Oregon Health and Science University
3181 SW Sam Jackson Park Road
Portland, Oregon 97239

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How to cite this article:
Liew J, Luo J, Forrest G, Obley A. Scedosporium brain abscess in an individual with Crohn's disease on chronic immunosuppression. J Case Rep Images Med 2016;2:78–82.


Abstract
Introduction: Scedosporium species are ubiquitous molds found in the environment that are uncommon pathogens in humans. Infections usually occur in immunosuppressed hosts. Scedosporium infection of the central nervous system is an even rarer manifestation that has mostly been described in transplant recipients and in cases of near-drowning.
Case Report: We present a case of an elderly man with a history of Crohn's disease on moderate immunosuppressive therapy, who presented with subacute progressive encephalopathy and was found to have a rim-enhancing lesion in the left frontal lobe. Cultures from biopsy of the lesion grew Scedosporium apiospermum. Although the patient was appropriately treated with voriconazole, he eventually succumbed to complications of his illness.
Conclusion: This case highlights that Scedosporium, an increasingly recognized opportunistic pathogen, should be considered in the differential of rim-enhancing brain lesions, even in patients with lesser degrees of immunosuppression. Clinical suspicion and early diagnosis is critical because Scedosporium species are resistant to many antifungal agents including amphotericin B, but may respond to voriconazole.

Keywords: Brain abscess, Crohn's disease, Fungal infection, Immunosuppression, Opportunistic infection


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Author Contributions
Jean Liew – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Jia Luo – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Graeme Forrest – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Adam Obley – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Guarantor of submission
The corresponding author is the guarantor of submission.
Source of support
None
Conflict of interest
Authors declare no conflict of interest.
Copyright
© 2016 Jean Liew et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.



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