Forensic Neuropathologic Phenotypes of Fungal Central Nervous System Infections: A Case Series

Gary Wu, From the Rush Medical College, Rush University, Chicago, IL.
Ying Liu, Department of Pathology and Laboratory Medicine, University of California-Davis, Sacramento, CA.
Elena Bulakhtina, Hamilton Regional Forensic Pathology Unit, Hamilton, Ontario.
Jennifer L. Hammers, Forensic Science and Law Program, Duquesne University, Pittsburgh, PA.
Erin M. Linde, Physicians Laboratory, Omaha, NE.
Bennet I. Omalu, Department of Pathology and Laboratory Medicine, University of California-Davis, Sacramento, CA.

Abstract

Fungal infections of the central nervous system (FI-CNS) are life-threatening infections that most commonly affect immunocompromised individuals, but immunocompetent individuals may also be infected. Although FI-CNS are relatively rare, the prevalence of FI-CNS is on the rise because of the increasing number of transplant recipients, human immunodeficiency virus-infected individuals, and use of immunosuppressive therapies. Most cases of FI-CNS originate from outside the central nervous system. The etiologic fungi can be classified into 3 fungal groups: molds, dimorphic fungi, and yeasts. The clinical presentation of FI-CNS is highly variable and may be difficult to diagnose premortem. We present a case series of 3 patients, each infected by 1 representative species from each of the 3 fungal groups (Aspergillus species, Blastomyces species, Candida species) to illustrate different neuropathologic phenotypes of FI-CNS. All 3 patients had no history of immunodeficiency and were not suspected to have FI-CNS until they were diagnosed at autopsy. Fungal infections of the central nervous system are often fatal due to delayed diagnosis and diagnostic testing. Awareness of such poly-phenotypic manifestations of FI-CNS will be helpful in reducing delayed diagnosis. It is important for clinicians to include FI-CNS on the differential diagnosis when radiographic findings are nonspecific.