Infratentorial subdural effusion: an imaging hint of a first-seen intracerebral Corynespora cassiicola infection

Excerpt

An immunocompetent 22-year-old man was admitted to intensive care unit (ICU) for coma and progressive cerebellar herniation. He presented with headache, worsening consciousness and fever for 1 month. Magnetic resonance imaging (MRI) on admission was characterized by infratentorial subdural effusion, and bilateral, symmetric leptomeningeal enhancement and parenchymal abnormality in the cerebellum (Fig. 1a, b, c). Cerebrospinal fluid (CSF) galactomannan (GM) was elevated. Corynespora cassiicola was identified using next-generation sequencing (NGS) of CSF. He was treated with 41-day amphotericin B (100 mg qd) and voriconazole (200 mg q12h), and 5-day immunoglobulin (20 g qd). MRI abnormality diminished at 39 days of antifungal therapy (Fig. 1d). He recovered with a Glasgow Coma Scale (GCS) of E4VTM5 and was released after 51 days in ICU. He continued antifungal treatment at a local hospital for 2 months and was able to walk independently.

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