Posters
Presentation Type
Poster
Discipline Track
Clinical Science
Abstract Type
Case Report
Abstract
Introduction:
We present a 31 y.o previously healthy woman who developed Fusarium solani fungal meningitis after undergoing cosmetic surgeries in Mexico. Fungal meningitis and particularly F. solani meningitis is very rare, and little is known about the extent and frequency of neurovascular complications in patients with this condition. To our knowledge, previous reports of fungal meningitis don’t recognize or emphasize enough the importance and extension of neurovascular complications noticed in our patient.
Case Presentation: A 31-year-old female presented with severe headaches and intermittent fever, two weeks after receiving epidural anesthesia during cosmetic surgery near the Texas-Mexico border. Lab results showed normal WBC at 3.3 x10(3)/mc, and a high-titer ANA of 1:32 but negative for rheumatoid factor, anti-Ro/SSA, Anti-La/SSB, anti-smith and anti-dsDNA, anti-cardiolipin Ab (IgA, IgG, IgM), and lupus anticoagulant. CSF analysis revealed cloudy fluid with an opening pressure of 25cm, a WBC count of 712 per mm3, protein levels of 50 mg/dl, and glucose levels of 38 mg/dl. Other studies, including routine bacterial CSF cultures were unrevealing.
Empirical therapy with Amphotericin and Voriconazole was initiated. A CSF 1,3 B-D glucan testing was over 500. Magnetic resonance venography (MRV) reported increased intracranial pressure. A repeated LP opening pressure was 35cm H2O, glucose was 30 mg/dl, protein levels were over 200 mg/dl, and a WBC count of 743 per mm3. Subsequently, a fungal broad-range PCR and next generation sequencing of the CSF confirmed the presence of Fusarium solani.
Despite receiving Intravenous (IV) dual antifungal therapy, the patient's severe headaches and nausea persisted, A cerebral angiogram identified a mycotic aneurysm on the left RCA, treated with an external ventricular drain and coil embolization. She remained in the medical intensive care unit (MICU) to receive ongoing antifungal therapy and close monitoring.
Conclusion: Fungal meningitis is predominantly observed in immunocompromised patients, with rare occurrences in immunocompetent individuals. However, our patient developed fungal meningitis following epidural anesthesia, presumptively with contaminated medications and/or equipment. Broad-range PCR of the CSF provided the opportunity to achieve a rapid diagnosis.s. Screening for infection in exposed patients and prompt initiation of empirical dual antifungal therapy is essential to optimize outcomes. CSF testing, such as B-D glucan, can also help to provide a presumptive non-specific diagnosis of fungal meningitis. To our knowledge, this was the first confirmed case of F.solani meningitis during this outbreak, helping guide therapy for this and other exposed patients here and elsewhere. The course of our patient's illness also suggests that ongoing severe headaches and changes in the headache patterns should be further investigated for neurovascular complications, including intracranial hypertension, vasculitis, and mycotic aneurysms. A multidisciplinary collaboration, including Internal Medicine, Infectious Disease, pharmacists, neurosurgeons, and neurologists, has been crucial for the comprehensive care of our patients.
Academic/Professional Position
Medical Student
Academic/Professional Position (Other)
MS3
Recommended Citation
Bouls, Ruayda; Ngo, Duc Khiem; and Campo Maldonado, Jose E., "Mycotic Aneurysms in Fungal Meningitis: The management in a case of Fusarium Solani meningitis" (2024). Research Symposium. 39.
https://scholarworks.utrgv.edu/somrs/2023/posters/39
Included in
Mycotic Aneurysms in Fungal Meningitis: The management in a case of Fusarium Solani meningitis
Introduction:
We present a 31 y.o previously healthy woman who developed Fusarium solani fungal meningitis after undergoing cosmetic surgeries in Mexico. Fungal meningitis and particularly F. solani meningitis is very rare, and little is known about the extent and frequency of neurovascular complications in patients with this condition. To our knowledge, previous reports of fungal meningitis don’t recognize or emphasize enough the importance and extension of neurovascular complications noticed in our patient.
Case Presentation: A 31-year-old female presented with severe headaches and intermittent fever, two weeks after receiving epidural anesthesia during cosmetic surgery near the Texas-Mexico border. Lab results showed normal WBC at 3.3 x10(3)/mc, and a high-titer ANA of 1:32 but negative for rheumatoid factor, anti-Ro/SSA, Anti-La/SSB, anti-smith and anti-dsDNA, anti-cardiolipin Ab (IgA, IgG, IgM), and lupus anticoagulant. CSF analysis revealed cloudy fluid with an opening pressure of 25cm, a WBC count of 712 per mm3, protein levels of 50 mg/dl, and glucose levels of 38 mg/dl. Other studies, including routine bacterial CSF cultures were unrevealing.
Empirical therapy with Amphotericin and Voriconazole was initiated. A CSF 1,3 B-D glucan testing was over 500. Magnetic resonance venography (MRV) reported increased intracranial pressure. A repeated LP opening pressure was 35cm H2O, glucose was 30 mg/dl, protein levels were over 200 mg/dl, and a WBC count of 743 per mm3. Subsequently, a fungal broad-range PCR and next generation sequencing of the CSF confirmed the presence of Fusarium solani.
Despite receiving Intravenous (IV) dual antifungal therapy, the patient's severe headaches and nausea persisted, A cerebral angiogram identified a mycotic aneurysm on the left RCA, treated with an external ventricular drain and coil embolization. She remained in the medical intensive care unit (MICU) to receive ongoing antifungal therapy and close monitoring.
Conclusion: Fungal meningitis is predominantly observed in immunocompromised patients, with rare occurrences in immunocompetent individuals. However, our patient developed fungal meningitis following epidural anesthesia, presumptively with contaminated medications and/or equipment. Broad-range PCR of the CSF provided the opportunity to achieve a rapid diagnosis.s. Screening for infection in exposed patients and prompt initiation of empirical dual antifungal therapy is essential to optimize outcomes. CSF testing, such as B-D glucan, can also help to provide a presumptive non-specific diagnosis of fungal meningitis. To our knowledge, this was the first confirmed case of F.solani meningitis during this outbreak, helping guide therapy for this and other exposed patients here and elsewhere. The course of our patient's illness also suggests that ongoing severe headaches and changes in the headache patterns should be further investigated for neurovascular complications, including intracranial hypertension, vasculitis, and mycotic aneurysms. A multidisciplinary collaboration, including Internal Medicine, Infectious Disease, pharmacists, neurosurgeons, and neurologists, has been crucial for the comprehensive care of our patients.