Multiple brain abscesses due to Penicillium spp. infection

Introduction

A 41-year-old man, with chronic liver disease caused by long-term HBV infection (Child–Pugh C), presented to the Emergency Department complaining of bilateral loss of visual fields and dysphasia for 3 days. CT scan and MRI revealed multiple brain abscesses. Stereothacic biopsies revealed fungal infection and amphotericin B treatment was begun with initial improvement. The patient died a few days later as a consequence of massive gastrointestinal bleeding due to ruptured esophageal varices. The final microbiologic analyses disclosed infection by Penicillium spp.

Discussion

Approximately 225 species of Penicillium have already been described. Systemic penicilliosis is a fungal infection caused by the dimorphic fungi Penicillium marneffei, a pathogenic species of the Penicillium genera. Segretain initially isolated this species in captive bamboo rats (Rhysomys sinesis) at the Pasteur Institute in 1956. Few cases have been described since then, until the emergence of a widespread AIDS epidemic in the Southern Asia, when it became an endemic infection among AIDS patients. Systemic penicilliosis is an extremely rare disease in the non-immunocompromised host. In the HIV-infected patients it is predominantly a late occurrence, with CD4 count normally around 50 cells/mm. Fever and weight loss are the most common first clinical manifestations, present in up to 95% of cases. The respiratory system is the most common organ affected. Cutaneous manifestations are frequent (up to 75% of cases) and are very important clues to the clinical diagnosis of penicilliosis. Over the past 50 years, according to a recent review, a total of 34 cases of invasive infection have been described in the literature, most of them associated with non-immunocompromised hosts. Regarding CNS infection, only three cases had already been reported, two of them in non-immunocompromised patients [1].

Figure 1

Conclusion

To our knowledge, this is the fourth documented case of CNS infection by a member of the Penicillium genera in the world, and the first one in Brazil.