Resolution of a fungal mycotic aneurysm after a contaminated steroid injection: A case report

George Nelson, Olga Fermo, Kiran Thakur, Elizabeth Felton, Jee Bang, Lucy Wilson, Susan Rhee, Rafael H Llinas, Kristine Johnson, David J Sullivan

Research output: Contribution to journalArticle

Abstract

Background: In the past ten years there have been three separate outbreaks of fungal contaminated steroid injections from compounding pharmacies. The 2012 outbreak of central nervous system fungal infections associated with contaminated methylprednisolone produced by a United States compounding pharmacy has led to 750 infections (151 with meningitis and paraspinal infections and 325 cases with paraspinal infections without meningitis) and 64 deaths as of October 23, 2013. Exserohilum rostratum has been the predominant pathogen identified by culture, polymerase chain reaction or antibody tests. According to previous reports, cerebral involvement with phaeohyphomycosis has a high risk of morbidity and mortality. Case presentation. We report a 41 year-old Caucasian woman who received a lumbar methylprednisolone injection from a contaminated lot in August 2012. She was diagnosed with fungal meningitis by cerebrospinal fluid pleocytosis and positive (1, 3) beta-D-glucan after cultures and polymerase chain reaction were negative. Two weeks after onset of therapy, she developed a 4.1 mm superior cerebellar artery mycotic aneurysm associated with new stroke symptoms, which resolved with thirty-two weeks of antifungal treatment. Conclusions: This is the rare case report of successful medical management of a cerebral mycotic aneurysm with stroke symptoms related to a presumed phaeohyphomycosis in an immunocompetent individual. Further studies are needed to determine the utility of cerebrospinal fluid (1, 3) beta-D-glucan in diagnosing and monitoring patients with meningitis thought to be related to fungal infection.

Original languageEnglish (US)
Article number327
JournalBMC Research Notes
Volume7
Issue number1
DOIs
StatePublished - May 31 2014

Fingerprint

Infected Aneurysm
Cerebrospinal fluid
Polymerase chain reaction
Methylprednisolone
Phaeohyphomycosis
Meningitis
Steroids
Patient monitoring
Injections
Disease Outbreaks
Central Nervous System Fungal Infections
Cerebrospinal Fluid
Fungal Meningitis
Neurology
Pathogens
Infection
Stroke
Polymerase Chain Reaction
Mycoses
Pharmacies

Keywords

  • (1,3) beta-D-glucan
  • Fungal polysaccharides
  • Infected aneurysm
  • Mycoses
  • Voriconazole

ASJC Scopus subject areas

  • Biochemistry, Genetics and Molecular Biology(all)
  • Medicine(all)

Cite this

Resolution of a fungal mycotic aneurysm after a contaminated steroid injection : A case report. / Nelson, George; Fermo, Olga; Thakur, Kiran; Felton, Elizabeth; Bang, Jee; Wilson, Lucy; Rhee, Susan; Llinas, Rafael H; Johnson, Kristine; Sullivan, David J.

In: BMC Research Notes, Vol. 7, No. 1, 327, 31.05.2014.

Research output: Contribution to journalArticle

Nelson, George ; Fermo, Olga ; Thakur, Kiran ; Felton, Elizabeth ; Bang, Jee ; Wilson, Lucy ; Rhee, Susan ; Llinas, Rafael H ; Johnson, Kristine ; Sullivan, David J. / Resolution of a fungal mycotic aneurysm after a contaminated steroid injection : A case report. In: BMC Research Notes. 2014 ; Vol. 7, No. 1.
@article{f4efd1de6dfc4feab9faa44061e8bd04,
title = "Resolution of a fungal mycotic aneurysm after a contaminated steroid injection: A case report",
abstract = "Background: In the past ten years there have been three separate outbreaks of fungal contaminated steroid injections from compounding pharmacies. The 2012 outbreak of central nervous system fungal infections associated with contaminated methylprednisolone produced by a United States compounding pharmacy has led to 750 infections (151 with meningitis and paraspinal infections and 325 cases with paraspinal infections without meningitis) and 64 deaths as of October 23, 2013. Exserohilum rostratum has been the predominant pathogen identified by culture, polymerase chain reaction or antibody tests. According to previous reports, cerebral involvement with phaeohyphomycosis has a high risk of morbidity and mortality. Case presentation. We report a 41 year-old Caucasian woman who received a lumbar methylprednisolone injection from a contaminated lot in August 2012. She was diagnosed with fungal meningitis by cerebrospinal fluid pleocytosis and positive (1, 3) beta-D-glucan after cultures and polymerase chain reaction were negative. Two weeks after onset of therapy, she developed a 4.1 mm superior cerebellar artery mycotic aneurysm associated with new stroke symptoms, which resolved with thirty-two weeks of antifungal treatment. Conclusions: This is the rare case report of successful medical management of a cerebral mycotic aneurysm with stroke symptoms related to a presumed phaeohyphomycosis in an immunocompetent individual. Further studies are needed to determine the utility of cerebrospinal fluid (1, 3) beta-D-glucan in diagnosing and monitoring patients with meningitis thought to be related to fungal infection.",
keywords = "(1,3) beta-D-glucan, Fungal polysaccharides, Infected aneurysm, Mycoses, Voriconazole",
author = "George Nelson and Olga Fermo and Kiran Thakur and Elizabeth Felton and Jee Bang and Lucy Wilson and Susan Rhee and Llinas, {Rafael H} and Kristine Johnson and Sullivan, {David J}",
year = "2014",
month = "5",
day = "31",
doi = "10.1186/1756-0500-7-327",
language = "English (US)",
volume = "7",
journal = "BMC Research Notes",
issn = "1756-0500",
publisher = "BioMed Central",
number = "1",

}

TY - JOUR

T1 - Resolution of a fungal mycotic aneurysm after a contaminated steroid injection

T2 - A case report

AU - Nelson, George

AU - Fermo, Olga

AU - Thakur, Kiran

AU - Felton, Elizabeth

AU - Bang, Jee

AU - Wilson, Lucy

AU - Rhee, Susan

AU - Llinas, Rafael H

AU - Johnson, Kristine

AU - Sullivan, David J

PY - 2014/5/31

Y1 - 2014/5/31

N2 - Background: In the past ten years there have been three separate outbreaks of fungal contaminated steroid injections from compounding pharmacies. The 2012 outbreak of central nervous system fungal infections associated with contaminated methylprednisolone produced by a United States compounding pharmacy has led to 750 infections (151 with meningitis and paraspinal infections and 325 cases with paraspinal infections without meningitis) and 64 deaths as of October 23, 2013. Exserohilum rostratum has been the predominant pathogen identified by culture, polymerase chain reaction or antibody tests. According to previous reports, cerebral involvement with phaeohyphomycosis has a high risk of morbidity and mortality. Case presentation. We report a 41 year-old Caucasian woman who received a lumbar methylprednisolone injection from a contaminated lot in August 2012. She was diagnosed with fungal meningitis by cerebrospinal fluid pleocytosis and positive (1, 3) beta-D-glucan after cultures and polymerase chain reaction were negative. Two weeks after onset of therapy, she developed a 4.1 mm superior cerebellar artery mycotic aneurysm associated with new stroke symptoms, which resolved with thirty-two weeks of antifungal treatment. Conclusions: This is the rare case report of successful medical management of a cerebral mycotic aneurysm with stroke symptoms related to a presumed phaeohyphomycosis in an immunocompetent individual. Further studies are needed to determine the utility of cerebrospinal fluid (1, 3) beta-D-glucan in diagnosing and monitoring patients with meningitis thought to be related to fungal infection.

AB - Background: In the past ten years there have been three separate outbreaks of fungal contaminated steroid injections from compounding pharmacies. The 2012 outbreak of central nervous system fungal infections associated with contaminated methylprednisolone produced by a United States compounding pharmacy has led to 750 infections (151 with meningitis and paraspinal infections and 325 cases with paraspinal infections without meningitis) and 64 deaths as of October 23, 2013. Exserohilum rostratum has been the predominant pathogen identified by culture, polymerase chain reaction or antibody tests. According to previous reports, cerebral involvement with phaeohyphomycosis has a high risk of morbidity and mortality. Case presentation. We report a 41 year-old Caucasian woman who received a lumbar methylprednisolone injection from a contaminated lot in August 2012. She was diagnosed with fungal meningitis by cerebrospinal fluid pleocytosis and positive (1, 3) beta-D-glucan after cultures and polymerase chain reaction were negative. Two weeks after onset of therapy, she developed a 4.1 mm superior cerebellar artery mycotic aneurysm associated with new stroke symptoms, which resolved with thirty-two weeks of antifungal treatment. Conclusions: This is the rare case report of successful medical management of a cerebral mycotic aneurysm with stroke symptoms related to a presumed phaeohyphomycosis in an immunocompetent individual. Further studies are needed to determine the utility of cerebrospinal fluid (1, 3) beta-D-glucan in diagnosing and monitoring patients with meningitis thought to be related to fungal infection.

KW - (1,3) beta-D-glucan

KW - Fungal polysaccharides

KW - Infected aneurysm

KW - Mycoses

KW - Voriconazole

UR - http://www.scopus.com/inward/record.url?scp=84902539710&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84902539710&partnerID=8YFLogxK

U2 - 10.1186/1756-0500-7-327

DO - 10.1186/1756-0500-7-327

M3 - Article

C2 - 24885172

AN - SCOPUS:84902539710

VL - 7

JO - BMC Research Notes

JF - BMC Research Notes

SN - 1756-0500

IS - 1

M1 - 327

ER -