# An Unusual Cause of Cerebellitis in an Immunosuppressed Elderly Man: Disseminated Scedosporium boydii Following Gardening-Related Injury

## TL;DR

An elderly man with a weakened immune system developed a rare fungal infection after a gardening injury, leading to severe neurological symptoms and death.

## Contribution

This case report presents an atypical source of Scedosporium boydii infection linked to a gardening-related injury rather than near-drowning.

## Key findings

- Scedosporium boydii was isolated from a skin lesion and linked to cerebellitis in an immunosuppressed patient.
- The infection presented with neurological symptoms initially mistaken for malignancy or infarction.
- Despite antifungal treatment, the patient's condition worsened and resulted in multiorgan failure.

## Abstract

Scedosporium boydii is an uncommon but increasingly recognized cause of opportunistic infections, particularly in immunocompromised individuals. We describe the case of a 92-year-old man on long-term corticosteroids who presented with progressive gait instability, confusion, and posterior headache. Initial neuroimaging revealed parietal-occipital and cerebellar lesions, raising concerns for malignancy or infarction. Although corticosteroid therapy initially provided temporary symptom relief, the patient subsequently deteriorated. Skin changes consistent with cellulitis were developed in the upper limb, and rapid progression of neurological lesions on repeat imaging, findings more suggestive of an infectious rather than a malignant process. Cultures from the skin lesion grew S. boydii, prompting the initiation of voriconazole and flucytosine. Despite appropriate antifungal therapy, the patient’s condition worsened, culminating in multiorgan failure and death. Retrospective history revealed a fall in a muddy garden, suggesting direct cutaneous inoculation as the source of infection, an atypical presentation since most cases are associated with near-drowning incidents. This case highlights the diagnostic challenges posed by rare fungal central nervous system infections that mimic more common intracranial pathologies and underscores the importance of early tissue sampling and multidisciplinary collaboration in managing such complex cases.