Resolution of a fungal mycotic aneurysm after a contaminated steroid injection: a case report
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...
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| Veröffentlicht in: | BMC research notes 2014-05, Vol.7 (1), p.327-327, Article 327 |
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| creator | Nelson, George Fermo, Olga Thakur, Kiran Felton, Elizabeth Bang, Jee Wilson, Lucy Rhee, Susan Llinas, Rafael Johnson, Kristine Sullivan, David |
| description | 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.
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.
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. |
| doi_str_mv | 10.1186/1756-0500-7-327 |
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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.
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.</description><identifier>ISSN: 1756-0500</identifier><identifier>EISSN: 1756-0500</identifier><identifier>DOI: 10.1186/1756-0500-7-327</identifier><identifier>PMID: 24885172</identifier><language>eng</language><publisher>England: BioMed Central Ltd</publisher><subject>Adult ; Aneurysm - complications ; Aneurysm - drug therapy ; Antibodies ; Antifungal Agents - therapeutic use ; Case Report ; Disease control ; Drug therapy ; Exserohilum rostratum ; Female ; Health aspects ; Hospitals ; Humans ; Medical imaging ; Meningitis, Fungal - complications ; Meningitis, Fungal - drug therapy ; Mycoses - complications ; Mycoses - drug therapy ; NMR ; Nuclear magnetic resonance ; Patient outcomes ; Pharmacy ; Stroke (Disease) ; Veins & arteries ; Viral antibodies ; Voriconazole - therapeutic use</subject><ispartof>BMC research notes, 2014-05, Vol.7 (1), p.327-327, Article 327</ispartof><rights>COPYRIGHT 2014 BioMed Central Ltd.</rights><rights>2014 Nelson et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.</rights><rights>Copyright © 2014 Nelson et al.; licensee BioMed Central Ltd. 2014 Nelson et al.; licensee BioMed Central Ltd.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-b5297-df2f8200643f8ecd955686f9cacc16875db858120fa8352ad25f287cfb4797a63</citedby><cites>FETCH-LOGICAL-b5297-df2f8200643f8ecd955686f9cacc16875db858120fa8352ad25f287cfb4797a63</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4057927/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4057927/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,864,885,27923,27924,53790,53792</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24885172$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Nelson, George</creatorcontrib><creatorcontrib>Fermo, Olga</creatorcontrib><creatorcontrib>Thakur, Kiran</creatorcontrib><creatorcontrib>Felton, Elizabeth</creatorcontrib><creatorcontrib>Bang, Jee</creatorcontrib><creatorcontrib>Wilson, Lucy</creatorcontrib><creatorcontrib>Rhee, Susan</creatorcontrib><creatorcontrib>Llinas, Rafael</creatorcontrib><creatorcontrib>Johnson, Kristine</creatorcontrib><creatorcontrib>Sullivan, David</creatorcontrib><title>Resolution of a fungal mycotic aneurysm after a contaminated steroid injection: a case report</title><title>BMC research notes</title><addtitle>BMC Res Notes</addtitle><description>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.
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.
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.</description><subject>Adult</subject><subject>Aneurysm - complications</subject><subject>Aneurysm - drug therapy</subject><subject>Antibodies</subject><subject>Antifungal Agents - therapeutic use</subject><subject>Case Report</subject><subject>Disease control</subject><subject>Drug therapy</subject><subject>Exserohilum rostratum</subject><subject>Female</subject><subject>Health aspects</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Medical imaging</subject><subject>Meningitis, Fungal - complications</subject><subject>Meningitis, Fungal - drug therapy</subject><subject>Mycoses - complications</subject><subject>Mycoses - drug therapy</subject><subject>NMR</subject><subject>Nuclear magnetic resonance</subject><subject>Patient outcomes</subject><subject>Pharmacy</subject><subject>Stroke (Disease)</subject><subject>Veins & arteries</subject><subject>Viral antibodies</subject><subject>Voriconazole - 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complications</topic><topic>Aneurysm - drug therapy</topic><topic>Antibodies</topic><topic>Antifungal Agents - therapeutic use</topic><topic>Case Report</topic><topic>Disease control</topic><topic>Drug therapy</topic><topic>Exserohilum rostratum</topic><topic>Female</topic><topic>Health aspects</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Medical imaging</topic><topic>Meningitis, Fungal - complications</topic><topic>Meningitis, Fungal - drug therapy</topic><topic>Mycoses - complications</topic><topic>Mycoses - drug therapy</topic><topic>NMR</topic><topic>Nuclear magnetic resonance</topic><topic>Patient outcomes</topic><topic>Pharmacy</topic><topic>Stroke (Disease)</topic><topic>Veins & arteries</topic><topic>Viral antibodies</topic><topic>Voriconazole - therapeutic use</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Nelson, George</creatorcontrib><creatorcontrib>Fermo, Olga</creatorcontrib><creatorcontrib>Thakur, Kiran</creatorcontrib><creatorcontrib>Felton, Elizabeth</creatorcontrib><creatorcontrib>Bang, Jee</creatorcontrib><creatorcontrib>Wilson, Lucy</creatorcontrib><creatorcontrib>Rhee, Susan</creatorcontrib><creatorcontrib>Llinas, Rafael</creatorcontrib><creatorcontrib>Johnson, Kristine</creatorcontrib><creatorcontrib>Sullivan, David</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Gale In Context: Opposing Viewpoints</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Natural Science Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>Biological Science Collection</collection><collection>ProQuest Central</collection><collection>Natural Science Collection</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>ProQuest Biological Science Collection</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Biological Science Database</collection><collection>Publicly Available Content Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>BMC research notes</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Nelson, George</au><au>Fermo, Olga</au><au>Thakur, Kiran</au><au>Felton, Elizabeth</au><au>Bang, Jee</au><au>Wilson, Lucy</au><au>Rhee, Susan</au><au>Llinas, Rafael</au><au>Johnson, Kristine</au><au>Sullivan, David</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Resolution of a fungal mycotic aneurysm after a contaminated steroid injection: a case report</atitle><jtitle>BMC research notes</jtitle><addtitle>BMC Res Notes</addtitle><date>2014-05-31</date><risdate>2014</risdate><volume>7</volume><issue>1</issue><spage>327</spage><epage>327</epage><pages>327-327</pages><artnum>327</artnum><issn>1756-0500</issn><eissn>1756-0500</eissn><abstract>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.
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.
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.</abstract><cop>England</cop><pub>BioMed Central Ltd</pub><pmid>24885172</pmid><doi>10.1186/1756-0500-7-327</doi><tpages>1</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Adult Aneurysm - complications Aneurysm - drug therapy Antibodies Antifungal Agents - therapeutic use Case Report Disease control Drug therapy Exserohilum rostratum Female Health aspects Hospitals Humans Medical imaging Meningitis, Fungal - complications Meningitis, Fungal - drug therapy Mycoses - complications Mycoses - drug therapy NMR Nuclear magnetic resonance Patient outcomes Pharmacy Stroke (Disease) Veins & arteries Viral antibodies Voriconazole - therapeutic use |
| title | Resolution of a fungal mycotic aneurysm after a contaminated steroid injection: a case report |
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