Disseminated blastomycosis with an intracranial fungoma in an immunocompetent patient: illustrative case

Annabelle Shaffer, Ryan Johnson, Gina Guglielmi, Anant Naik, Daniel Najafali, Amir A. Khan, Frank J. Bellafiore, Paul M. Arnold, Wael Hassaneen

Research output: Contribution to journalArticlepeer-review


BACKGROUND Blastomyces dermatitidis is a fungus endemic to central and southern North America. While infection most commonly results in pneumonia, a small number of infections progress to systemic disease, which may include intracranial lesions. Progression to systemic disease is most common in immunocompromised patients, such as those with human immunodeficiency virus. OBSERVATIONS The authors present a 44-year-old immunocompetent male who presented following a tonic-clonic seizure. Initial workup revealed a 19-mm enhancing intracranial mass. There was avid uptake of fluorescein sodium, and an en bloc resection of the mass was performed. Histopathology revealed B. dermatitidis. Medical management included amphotericin B and azole therapy. Postoperative recovery was uneventful, and no focal neurological deficits were appreciated. LESSONS This case highlights the neurosurgical management of a rare intracranial fungal manifestation in an immunocompetent patient. A literature review was also performed to better understand the role of neurosurgery in fungal infections. There were limited cases of intracranial Blastomyces reported in immunocompetent patients, and neurosurgical management varied (no intervention, biopsy, resection) and was underreported. Too few cases are reported to suggest neurosurgical intervention for blastomycosis improves outcomes. Medical management was relatively standard with azole and amphotericin therapy.

Original languageEnglish (US)
Article numberCASE22406
JournalJournal of Neurosurgery: Case Lessons
Issue number3
StatePublished - Jan 2023
Externally publishedYes


  • blastomycosis
  • central nervous system
  • fungoma
  • intracranial mass

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery


Dive into the research topics of 'Disseminated blastomycosis with an intracranial fungoma in an immunocompetent patient: illustrative case'. Together they form a unique fingerprint.

Cite this