amphotericin-b and Basal-Ganglia-Diseases

Cerebral mucormycosis (without associated involvement of and invasion from the nasal sinuses and turbinates) is an extremely rare opportunistic infection of the central nervous system. We report the case of an intravenous drug abuser (who was negative for the human immunodeficiency virus) who presented with hemiparesis on the right side, slurred speech, altered mental status, and an unsteady gait. Imaging studies revealed a large left-side basal ganglia lesion. A stereotactic biopsy obtained a tissue sample that revealed wide, nonseptated hyphal fragments with granulomatous inflammation. The patient was treated with 3 gm of amphotericin B during a 5-month period. The patient had no residual neurological dysfunction after treatment. Open surgical resection was not employed. This case suggests that stereotactic biopsy followed by long-term amphotericin B therapy, in lieu of open surgical resection, represents a viable treatment option for this rare disorder.

Topics: Adult; Amphotericin B; Basal Ganglia Diseases; Biopsy, Needle; Brain Abscess; Combined Modality Therapy; Humans; Male; Mucorales; Mucormycosis; Neurologic Examination; Stereotaxic Techniques

The subacute onset of parkinsonism in a patient with cryptococcal meningoencephalitis is described. The prompt resolution of the extrapyramidal dysfunction with antifungal agents suggests direct involvement of basal ganglia structures by the cryptococcal infection. Rapid development of parkinsonism in immunocompromised individuals should prompt investigation for an infectious etiology.

Topics: Aged; Aged, 80 and over; Amphotericin B; Basal Ganglia Diseases; Cryptococcosis; Flucytosine; Humans; Male; Meningoencephalitis; Parkinson Disease