The index case for the fungal meningitis outbreak in the United States

N Engl J Med. 2012 Nov 29;367(22):2119-25. doi: 10.1056/NEJMoa1212292. Epub 2012 Oct 19.

Abstract

Persistent neutrophilic meningitis presents a diagnostic challenge, because the differential diagnosis is broad and includes atypical infectious causes. We describe a case of persistent neutrophilic meningitis due to Aspergillus fumigatus in an immunocompetent man who had no evidence of sinopulmonary or cutaneous disease. An epidural glucocorticoid injection was identified as a potential route of entry for this organism into the central nervous system, and the case was reported to the state health department.

Publication types

  • Case Reports

MeSH terms

  • Aspergillosis / diagnosis*
  • Aspergillosis / etiology
  • Aspergillus fumigatus / isolation & purification*
  • Brain / diagnostic imaging
  • Brain / pathology*
  • Cerebellum / blood supply
  • Cerebral Infarction / etiology
  • Cerebral Infarction / pathology
  • Cerebrospinal Fluid / parasitology*
  • Diagnosis, Differential
  • Disease Outbreaks
  • Drug Contamination*
  • Fatal Outcome
  • Glucocorticoids / administration & dosage
  • Headache / etiology
  • Humans
  • Injections, Epidural / adverse effects
  • Intracranial Hemorrhages / diagnostic imaging
  • Intracranial Hemorrhages / etiology
  • Low Back Pain / drug therapy
  • Low Back Pain / etiology
  • Male
  • Meningitis, Fungal / diagnosis*
  • Meningitis, Fungal / epidemiology
  • Meningitis, Fungal / etiology
  • Middle Aged
  • Tomography, X-Ray Computed
  • United States

Substances

  • Glucocorticoids