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Case Report

Central nervous system blastomycosis presenting as

a year-long chronic headache

Elena Grebenciucova , Maciej S. Lesniak , Peter Pytel , Rimas V. Lukas 1
2
1
3
1 Department of Neurology, University of Chicago Medical Center, Chicago, IL 60637, USA.
2 Department of Neurosurgery, Northwestern University, Chicago, IL 60637, USA.
3 Department of Pathology, University of Chicago Medical Center, Chicago, IL 60637, USA.

Dr. Elena Grebenciucova is currently a senior neurology resident at the University of Chicago Medical Center.
Her interests lie in the field of neuroimmunology and neuro-infectious disorders. This year, she will continue
serving patients with neuroinflammatory diseases in a new capacity, as a Neuroimmunology fellow at the
University of Pennsylvania.

A B S T R AC T

This case describes a posterior fossa mass due to blastomycotic infection in a non-immunocompromised 41-year-old male
presenting with a chronic headache for over one year. Given the risk of herniation, no lumbar puncture could be performed. A
full work-up found no evidence of systemic infection. Surgical resection helped identify the mass as a blastomycotic abscess.
Magnetic resonance imaging characteristics of the mass were helpful in the identification of the mass as a fungal abscess.
Key words: CNS blastomycosis; blastomycotic abscess; chronic headache; posterior fossa mass; fungal abscess

INTRODUCTION CASE REPORT

Blastomycosis isolated to the central nervous system (CNS) A 41 years old male from rural Illinois with a history
is exceedingly rare. In the absence of other more common of hypertension and alcohol abuse presented for
systems’ involvement (such as lungs), blastomycosis is evaluation of 16 months of progressive dull occipital
rarely considered high on the differential. This case headaches, unresponsive to pain medications. Over the
describes a nonspecific presentation of a blastomycotic prior 6 months the patient developed nausea with rapid
abscess as a chronic headache and discusses the head movements as well as dysarthria and right hand
clumsiness. Non-contrast computed tomography (CT)
difficulties associated with the prompt diagnosis of this of the brain demonstrated an ill-defined mixed density
disease. The scope of this case is to demonstrate that lesion in the cerebellum [Figure 1]. Magnetic resonance
when presenting as a posterior fossa mass, blastomycotic imaging (MRI) revealed a 3.5 cm × 2.6 cm intra-axial
abscesses have a vast differential and ultimately require mass in the midline superior cerebellum abutting the
a biopsy or resection for the correct diagnosis. MRI tentorium and compressing the 4th ventricle. The mass
imaging may be helpful in helping distinguish fungal was mildly hyperintense on T1-weighted images and
abscesses from their neoplastic or bacterial counterparts. heterogeneous but predominately hypointense on T2/
FLAIR [Figure 2]. It demonstrated significant internal
Corresponding Author: Dr. Elena Grebenciucova, Department susceptibility on susceptibility weighted images
of Neurology, University of Chicago Medical Center, Chicago, IL compatible with vascularity and/or hemorrhage. There
60637, USA. Email: elena.grebenciucova@uchospitals.edu
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Cite this article as: Grebenciucova E, Lesniak MS, Pytel P, Lukas RV.
DOI: 10.20517/2347-8659.2015.26 Central nervous system blastomycosis presenting as a year-long chronic
headache. Neuroimmunol Neuroinflammation 2016;3:17-9.
Received: 12-06-2015; Accepted: 01-10-2015

© 2016 Neuroimmunology and Neuroinflammation | Published by OAE Publishing Inc. 17