Pseudallescheria boydii infection of the central nervous system
P. Kershaw, R. Freeman, D. Templeton, P. C. DeGirolami, U. DeGirolami, D. Tarsy, S. Hoffmann, G. Eliopoulos and A. W. Karchmer
Department of Neurology, Boston City Hospital, MA.
Pseudallescheria boydii is a rare cause of central nervous system infection
characteristically presenting as a neutrophilic meningitis or multiple
brain abscesses. Factors predisposing to central nervous system infection
with this fungus include immunosuppression and near drowning. The organism
is infrequently cultured from fluid obtained by lumbar puncture, delaying
clinical recognition and appropriate antifungal therapy. All untreated
patients with P boydii infection of the central nervous system died. We
describe a patient who developed a persistent neutrophilic meningitis with
focal neurologic deficits due to P boydii 6 months after a freshwater
aspiration pneumonia. We also review the characteristic clinical and
pathologic features of previously reported cases and emphasize the
importance of early detection and treatment in the management of this
frequently intractable disease.
