Scedosporium brain abscess in an individual with Crohn’s disease on chronic immunosuppression

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 Jean Liew1, Jia Luo1, Graeme Forrest2, Adam Obley3 Affiliations: 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. Corresponding Author: Jean Liew, MD, Department of Medicine, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Portland, Oregon 97239; E-mail: [email protected] Received: 29 June 2016 Accepted: 23 July 2016 Published: 05 September 2016 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.