A 24-year-old man presented with a 2-day history of headache, confusion, and left hemiparesis. He was previously in good health, was not immunocompromised, and tested negative for human immunodeficiency virus infection. Magnetic resonance imaging showed a progressive, nonenhancing lesion involving the basal ganglia that extended into the midbrain with mass effect (Figure, A and B). Analysis of a biopsy specimen from the right caudate lobe showed neutrophil infiltration with broad fungal hyphae with irregular branching (Figure, C). A Rhizomucor species was grown on culture. Specific questioning revealed one occasion of intravenous amphetamine use in the week before admission. The patient died despite antifungal therapy with amphotericin B and external ventricular drainage.
Imaging results (A and B) and microscopic analysis of the biopsy specimen (C) in our patient. A and B, Fluid-attenuated inversion recovery (FLAIR) magnetic resonance imaging on admission (A) showing increased signal in the right basal ganglia. There was hypointensity on T1 imaging and patchy restricted diffusion, but no enhancement following administration of intravenous gadolinium. Repeat FLAIR imaging 48 hours later (B) showed spread to the left basal ganglia. C, Photomicrograph showing the broad hyphae with irregular branching typical of zygomycosis in an area of suppuration with background neutrophils (hematoxylin-eosin, original magnification ×400).
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