heroin and Cerebral-Ventriculitis

Fungal nervous system infection can be a difficult diagnosis to make, due to the fact that there are no specific manifestations of the disease and laboratory confirmation is difficult to confirm.. We report a young male who presented to our emergency department with a variety of unilateral visual field complaints. While he initially denied recent IV drug abuse, his physical examination was highly suggestive of a fungal infection known to result from brown heroin use. He was ultimately diagnosed with meningitis, ventriculitis, and endogenous endophthalmitis believed to result from a Candida species. The response to treatment with vitrectomy and broad-spectrum antimicrobials gave support to the presumed diagnosis. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: We provide a rarely described report of a possible complication from the use of IV brown heroin that led to a central nervous system infection involving vision loss by fungal infection.

Topics: Antifungal Agents; Candida; Central Nervous System Diseases; Cerebral Ventriculitis; Diagnosis, Differential; Emergency Service, Hospital; Endophthalmitis; Heroin; Humans; Male; Meningitis; Mycoses; Substance Abuse, Intravenous; Visual Fields; Voriconazole; Young Adult