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April 1990

Pseudallescheria boydii Infection of the Central Nervous System

Author Affiliations

From the Department of Neurology, Boston City Hospital (Dr Kershaw), the Departments of Neurology (Drs Freeman and Tarsy), Pathology (Drs Templeton, P. C. DeGirolami, and U. DeGirolami), and Medicine (Drs Hoffmann, Eliopoulos, and Karchmer), New England Deaconess Hospital, and the Department of Neurology, Beth Israel Hospital (Dr Freeman), Boston. Dr Kershaw is now with the Department of Medicine, Maui (Hawaii) Memorial Hospital.

Arch Neurol. 1990;47(4):468-472. doi:10.1001/archneur.1990.00530040126029

Pseudallescheria boydii is a rare cause of central nervous system infection characteristically presenting as a neutrophilic meningitis or multiple brain abscesses. Factors predisposing to central nervous system infection with this fungus include immunosuppression and near drowning. The organism is infrequently cultured from fluid obtained by lumbar puncture, delaying clinical recognition and appropriate antifungal therapy. All untreated patients with P boydii infection of the central nervous system died. We describe a patient who developed a persistent neutrophilic meningitis with focal neurologic deficits due to P boydii 6 months after a freshwater aspiration pneumonia. We also review the characteristic clinical and pathologic features of previously reported cases and emphasize the importance of early detection and treatment in the management of this frequently intractable disease.

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