A 24-year-old man presented with a 2-day history of headache, confusion, and left hemiparesis. He was previously in good health, was not immunocompromised, and tested negative for human immunodeficiency virus infection. Magnetic resonance imaging showed a progressive, nonenhancing lesion involving the basal ganglia that extended into the midbrain with mass effect (Figure, A and B). Analysis of a biopsy specimen from the right caudate lobe showed neutrophil infiltration with broad fungal hyphae with irregular branching (Figure, C). A Rhizomucor species was grown on culture. Specific questioning revealed one occasion of intravenous amphetamine use in the week before admission. The patient died despite antifungal therapy with amphotericin B and external ventricular drainage.
Pandian JD, McCarthy JS, Goldschlager T, Robertson T, Henderson RD. Rhizomycosis Infection in the Basal Ganglia. Arch Neurol. 2007;64(1):134–135. doi:10.1001/archneur.64.1.134