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Cerebral Scedosporium apiospermum infection presenting with intestinal manifestations
Authors:D. Lin  K. Qurat-Ul-Ain  S. Lai  D. M. Musher  R. Hamill
Affiliation:1. Department of Medicine, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX, 77030, USA
4. Medical Care Line, Pathology Section, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
2. Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, TX, USA
3. Medical Care Line, Infectious Disease Section, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
Abstract:We present a case of cerebral Scedosporium apiospermum infection presenting with intestinal manifestations in a 64-year-old male patient on immunosuppression for orthotopic liver transplantation. At admission, the patient’s chief complaint was chronic watery diarrhea and he was found to have colonic ulcers on endoscopy. His hospital course was complicated by a tonic–clonic seizure caused by a left frontal brain abscess, with the causative agent being identified by culture. He was treated with lobectomy, high-dose intravenous voriconazole, and liposomal amphotericin with clinical, endoscopic, and histologic improvement. To our knowledge, S. apiospermum has not been previously described as a cause of colitis. The septate branching appearance of the Scedosporium species is similar to the more common Aspergillus species. This case of gastrointestinal Scedosporium brings into question previously reported cases of isolated gastrointestinal aspergillosis diagnosed by histopathology. Clinical suspicion for S. apiospermum must be maintained in immunosuppressed patients presenting with neurologic and gastrointestinal symptoms.
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