A Case of Central Nervous System Infection Due to <i>Schizophyllum commune</i>

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  • Otsuka Koji
    Department of Otolaryngology/Head and Neck Surgery, Tokyo Medical University
  • Yatomi Masanori
    Department of Otolaryngology/Head and Neck Surgery, Tokyo Medical University
  • Okayoshi Yohei
    Department of Otolaryngology, Toda Chuo Hospital
  • Takeda Atsuo
    Department of Otolaryngology/Head and Neck Surgery, Tokyo Medical University Hachioji Medical Center
  • Hattori Kazuhiro
    Department of Otolaryngology, Kosei Chuo Hospital
  • Maruyama Ryo
    Department of Otolaryngology, Toda Chuo Hospital
  • Hirasawa Kazuhiro
    Department of Otolaryngology/Head and Neck Surgery, Tokyo Medical University
  • Tsukahara Kiyoaki
    Department of Otolaryngology/Head and Neck Surgery, Tokyo Medical University

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  • 蝶形骨洞から進展したスエヒロタケ（<i>Schizophyllum commune</i>）による中枢神経系真菌症例

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<p>Introduction: Central nervous system (CNS) infections due to filamentous basidiomycetes are extremely rare. We encountered a case of subdural abscess and hypertrophic pachymeningitis due to Schizophyllum commune that developed from sinusitis.</p><p>Case presentation: A 69-year-old woman visited our hospital with complaints of headache, right trigeminal neuralgia, dizziness, and right hearing loss. Magnetic resonance imaging revealed a mass in the right sphenoidal sinus and cerebellopontine angle. She initially underwent endoscopic sinus surgery (ESS), in which the mass lesion was removed from the right sphenoid sinus. The pathological specimens showed findings indicative of filamentous fungi on Grocott staining. However, her symptoms did not improve after ESS, and neuroendoscopic biopsy of intracranial lesions was performed as a secondary procedure. These specimens showed the same findings of filamentous fungi on Grocott staining. DNA sequencing of the sinus specimen revealed Schizophyllum as the causative pathogen, consistent with the diagnosis of fungal sinusitis and CNS infection. Treatment with liposomal amphotericin B drip infusion was started, but this resulted in no improvement and the treatment was switched to voriconazole drip infusion. Improvements in both radiological findings and symptoms were then observed. However, the symptoms exacerbated again when the trough level of voriconazole decreased. A subsequent increase in the voriconazole dose resulted in a higher trough level and improvement of symptoms.</p><p>Conclusions: This is a rare case report of CNS infection due to Schizophyllum. This case suggests that when these symptoms do not improve with liposomal amphotericin B, voriconazole administered at high trough levels can improve the symptoms.</p>

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