Naslov
Penicillium brevicompactum as a causative agent of the central nervous system infection in an immunocompromised patent

Autori
Tomasović, Domagoj ; Juraj, Krznarić ; Gjurašin, Branimir ; Marinković, Luka ; Bilić, Jaka ; Čičmak, Ana ; Marjanović, Marcel ; Marasanov Kavanagh, Sergej ; Višković, Klaudija ; Župetić, Ivana ; Planinc, Ivo ; Kutleša, Marko ; Santini, Marija

Vrsta, podvrsta i kategorija rada
Sažeci sa skupova, neobjavljeni rad, stručni

Skup
3rd South-East European conference on travel, tropical, migration medicine & HIV and 4th Croatian conference on travel, tropical, migration medicine and HIV

Mjesto i datum
Zadar, Hrvatska, 16.09.2021. - 19.09.2021

Vrsta sudjelovanja
Poster

Vrsta recenzije
Međunarodna recenzija

Ključne riječi
central nervous system (CNS) infection ; Penicillium brevicompactum

Sažetak
Objectives: To present a case of the central nervous system (CNS) infection caused by Penicillium brevicompactum in an immunocompromised patient. Case Report: A 63-year-old male patient with a history of heart transplantation was treated for COVID-19 at the University Hospital Centre Zagreb (UHCZ) in June 2021. During this hospitalization, he developed ethmoid and sphenoid sinusitis. His immunosuppression was modified (cyclosporine and tacrolimus stopped, prednisolone dose elevated), and voriconazole was administered. The patient deteriorated by developing fever, somnolence, vertigo, ataxia, diplopia and dysphagia. Brain MR revealed bitemporal corticosubcortical lesions, ischaemic lesion in the pons, and pansinusitis. Cerebrospinal fluid (CSF) analysis demonstrated mild pleocytosis with neutrophilia, normal glucose and protein, but elevated lactate level. The patient was transferred to the University Hospital for Infectious Diseases, Zagreb, Croatia. Broad microbiological tests performed on CSF did not yield causative agents. Empirical therapy with liposomal amphotericin B, meropenem and vancomycin was initiated. The patient's condition further deteriorated. A brain biopsy was performed, and it revealed fungal hyphae. A combination of liposomal amphotericin B and isavuconazole was continued. Penicillium brevicompactum was isolated from the biopsy sample. Endoscopic ethmoid and sphenoid sinus operation was performed in order to control the possible source of infection. Antifungal therapy combined with sinus surgery resulted in body temperature normalization, weaning from mechanical ventilation, the patient spontaneously opening his left eye, having right-sided ptosis with mydriasis, and tetraplegia. Conclusion: In immunocompromised patients with CNS infections, we can expect rare pathogens, challenging to detect. As a last resort, a brain biopsy could be considered in this subpopulation of patients (when all other options have been exausted), which may lead to exact diagnosis and targeted timely antimicrobial therapy.

Izvorni jezik
Engleski

Znanstvena područja
Kliničke medicinske znanosti

POVEZANOST RADA