Candida albicans cerebral granulomas associated with a nonfunctional cerebrospinal fluid shunt: Case report

OBJECTIVE AND IMPORTANCE: We report an unusual case of basal ganglia granul omas caused by Candida albicans that surrounded the proximal segment of a n onfunctional cerebrospinal fluid shunt in a previously healthy patient. CLINICAL PRESENTATION: A 22-year-old woman had undergone ventriculoatrial c erebrospinal fluid shunt placement for posttraumatic hydrocephalus 3 years previously. One year later, a shunt revision was followed by wound dehiscen ce with local infection at the neck level. She received oral administration of antibiotics for 3 months until the wound closed. Twelve weeks before ad mission, the patient experienced pulmonary emboli. She received anticoagula nts, and the distal segment of the shunt was removed. Five weeks after shun t removal, she presented with headache and left-sided hemiplegia caused by right basal ganglia inflammatory masses. INTERVENTION: A stereotactic brain biopsy was performed, and the shunt remn ants were removed. Microscopically, the lesions were acutely and chronicall y inflamed. C. albicans grew in tissue and in shunt hardware cultures. The patient was treated with 1.1 g of intravenously administered amphotericin B and orally administered ketoconazole; she recovered completely. CONCLUSION: C. albicans brain granulomas occur rarely in immunocompetent pa tients. Despite the large size of the lesions and severe brain edema, the a bsence of an underlying disease contributed to complete resolution after sh unt removal and antifungal therapy.