Fungal CNS infection in a term neonate: Can a radiologist help with diagnosis?

Abstract

Brain abscesses can be bacterial or fungal. It is usually difficult to distinguish between the two clinically as well as radiologically. However, careful scrutiny of the radiological images for subtle radiological signs and proper analysis of serial images can help in narrowing down the diagnosis and preventing delay in specific treatment.

We report an infant who initially presented with a small parietal hemorrhage and subsequently evolved into multiple brain abscesses. Since fungi and not bacteria are preferentially known to invade blood vessels, the infant had a radiological diagnosis of fungal abscess in the brain. Although the cerebrespinal fluid did not grow any fungal micro-organism, the infant clinically improved after the administration of anti-fungal antibiotics. Blood and urine cultures later grew Candida albicans.