The Potential Diagnostic Trap of Unexpected Intracranial Hyalohyplymycosis—A Case Report and Brief Literature Review

TL;DR

A rare case of intracranial fungal infection in an immunocompetent adult is reported, highlighting the importance of neurosurgical excision and antifungal therapy for diagnosis and treatment.

Contribution

This case report adds to the limited literature on intracranial hyalohyphomycosis in immunocompetent individuals and emphasizes the role of neurosurgery in diagnosis.

Findings

Neurosurgical excision and antifungal therapy led to a successful outcome in a rare case of intracranial hyalohyphomycosis.

The case highlights the diagnostic challenge of nonspecific neuroimaging results and the necessity of histopathological confirmation.

Trauma from boxing may have contributed to the infection's onset in an otherwise healthy individual.

Abstract

Background: Intracranial fungal infection represents a rare entity, especially in immunocompetent patients. The available neuroimaging methods may show nonspecific results; thus, a final diagnosis is based on histopathological examination. Methods: This report aims to describe a rare case of a young immunocompetent adult who developed a secondary skull base infection, probably due to primary sinonasal involvement. The patient was an 18-year-old immunocompetent male adult with intracranial hyalohyphomycosis, diagnosed and neurosurgically treated in the 3rd Neurosurgical Department of Clinical Emergency Hospital Bagdasar-Arseni. Results: The neurosurgical excision and intense antifungal therapy led to very good outcomes. The particularity of this case is highlighted by the local traumatic component due to boxing practice. The impact of presented cases of this kind is significant given the scarce information regarding this subject, and it can contribute to a better understanding of the underlying mechanisms of this pathology. Intracranial fungal infections are very rare and very often difficult to diagnose. Although it is known that their prognosis implies a mortality of up to 60% in immunocompromised patients, in immunocompetent cases, the exact characteristics of the disease, as well as the prognostic factors, are yet to be elucidated. Conclusions: The neuroimaging results are nonspecific in many cases, but a diagnosis is based on the histopathological results with specific features. Even though antifungal therapy is the main treatment for fungal infections, in cases of intracranial lesions, a diagnosis may be obtained after neurosurgical excision, and drug therapy will come second.

Figures