Eur Radiol (2006) 16: 496–502 DOI 10.1007/s00330-005-2869-8 NEURO Enrique Marco de Lucas Pablo Sádaba Pedro Lastra García-Barón María Luisa Ruiz Delgado Jorge Cuevas Ricardo Salesa Arancha Bermúdez Andrés González Mandly Agustín Gutiérrez Fidel Fernández Fernando Marco de Lucas Consuelo Díez Received: 10 March 2005 Revised: 13 June 2005 Accepted: 7 July 2005 Published online: 20 August 2005 # Springer-Verlag 2005 Cerebral scedosporiosis: an emerging fungal infection in severe neutropenic patients CT features and CT pathologic correlation Abstract Scedosporium prolificans is an emerging opportunistic fungal agent encountered in severely neutro- penic patients. The purpose of this paper is to describe the main cranial CT findings from a retrospective review of six patients (four men and two women, 18–66 years old) afflicted with disseminated infection by S. prolificans with neurological symp- toms. They were severely neutropenic and presented with severe respiratory failure and conscience deterioration, with a subsequent 100% mortality. The final diagnosis was established by autopsy (performed in five patients) and blood culture findings. Cranial CT showed multiple low-density lesions in four patients without contrast en- hancement located in the basal ganglia and corticomedullary junction. Autopsy findings of these lesions demonstrated necrosis and hyphae proliferation inside brain infarcts. Also, two of the patients had a subarachnoid hemorrhage, but angi- ography could not be performed. CT and autopsy findings were fairly similar to those encountered in cere- bral aspergillosis; however, possibly because of its rapid and fatal evolu- tion, no edema or ring enhancing lesions were encountered. Thus, Sce- dosporium can be included as a rare but possible cause of invasive fungal disseminated central nervous system infections in severely neutropenic patients. Keywords Aspergillosis . Fungi . Computed tomography (CT) . Scedosporium . Brain E. Marco de Lucas (*) . P. Sádaba . P. Lastra García-Barón . M. L. Ruiz Delgado . A. González Mandly . A. Gutiérrez . C. Díez Department of Radiology, Hospital Universitario Marqués de Valdecilla, Av. Valdecilla s/n, 39008 Santander, Cantabria, Spain e-mail: radmle@humv.es Tel.: +34-94-2203499 Fax: +34-94-2203495 J. Cuevas . F. Fernández Department of Pathology, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain R. Salesa Department of Microbiology, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain A. Bermúdez Department of Hematology, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain F. Marco de Lucas Department of Hematology, Hospital de Basurto, Bilbao, Vizcaya, Spain Introduction Invasive fungal infections represent a major threat to im- munocompromised patients like transplant recipients, es- pecially in bone marrow transplantation (BMT) with prolonged neutropenia. Aspergillus is by far the most fre- quent agent described in literature. However, in recent years clinicians have witnessed the emergence of several new fungal pathogens, usually underdiagnosed, with a clinical expansion after prophylactic use of antifungal therapies [1, 2]. These agents have been included in microbiological classification as phaeohyphomycosis, the majority of them caused by one species, Scedosporium prolificans [3]. It usually produces a rapid and fatal dis- semination because known antifungal therapies have no impact on final outcome. The development of newer ther-