Exserohilum rostratum fungal meningitis associated with methylprednisolone injections.

In October 2012, the CDC reported an outbreak of fungal meningitis associated with methylprednisolone injections [1]. Although the index case had Aspergillus fumigatus meningitis [2], subsequent reports indicated that the majority of affected patients had meningitis caused by Exserohilum rostratum, an extremely rare cause of human fungal disease [1,3,4]. The outbreak is presumably the result of direct inoculation of E. rostratumcontaminated methylprednisolone into human tissue, and the cause appears to be a manufacturing mishap. This is not the first instance of fungal meningitis resulting from contaminated steroid preparations. It was 10 years ago when several cases of fungal meningitis caused by Exophiala (Wangiella) dermatitidis occurred in patients receiving injectable steroids [5]. Further back in time, epidemics of zygomycosis occurred from the use of bandages and wood depressors, among others, that were contaminated with fungal spores [6]. Each of these outbreaks was characterized by high mortality and morbidity, thereby illustrating the potential of certain fungal species to cause life-threatening disease when they interact with human hosts in whom integument and mucosal defenses have been compromised by iatrogenic procedures.