Cerebral Blastomycosis in a Tunisian Woman

Abstract

Blastomycosis is a nonopportunistic fungal infection caused by Blastomyces dermatitidis. Infection of the central nervous system is an uncommon localization of this disease occurring only in 5-10% of cases. We report a new case of a 57-year-old woman, who was admitted in the neurosurgical department for severe headaches, vomiting, and a visual disturbance. Physical and biological investigations were normal. Magnetic resonance imaging leaded to find an intracranial and extracranial expansive process, measuring 42 mm in length. The microscopic examination revealed a chronic granulomatous inflammation, associating epitheloid and multinucleated giant cells containing thick walled budding yeast-like forms. Grocott-Gomori methenamine-silver (GMS) staining leaded to confirm its fungal nature and it was precisely, B. dermatitidis. The post-operative course was complicated by cerebral edema associated with an important cerebral hemorrhage. The patient died 11 days after the surgery. Cerebral involvement remains a serious but uncommon manifestation of Blastomycosis. It should be suspected in front of a granulomatous inflammation with the presence of spore, on the pathological examination. Delay in diagnosis has been reported to play a significant role in the high mortality rate.