A fatal case of Exophiala dermatitidis meningoencephalitis in an immunocompetent host: A case report and literature review

BackgroundCentral nervous system (CNS) infection due to Exophiala dermatitidis is rare and fatal, primarily reported in immunocompromised patients or those with caspase recruitment domain-containing protein 9 deficiency. Herein, we describe a case of an otherwise healthy person (without underlying disease gene deficiency) diagnosed meningoencephalitis. The patient achieved clinical remission under high-dose antifungal therapy the first 14 months but died after 2 years therapy.Case presentationA 15-year-old student headache fever was admitted our department. Lumbar puncture showed increased cerebrospinal fluid (CSF) pressure, moderately high CSF levels cell counts, remarkable decrease glucose chloride. Magnetic resonance imaging brain revealed multiple lesions cerebral pia mater enhancement. culture confirmed E. infection. We administered 4-week amphotericin B, his remained positive. After receiving 12-week standard dose voriconazole (200 mg q12h), patient's became negative, condition deteriorated intracranial lesion enlargement. (600–800 per day) for 12 months, which led remission. reduced adverse effects including hepatic dysfunction hypokalemia, progressed pressure epileptic seizures.ConclusionsCNS caused by fatal most serious form fungal Initially, long-term could be effective. Gene defect related immunodeficiency may important pathogenic lethal factor.