Sixty-five-year-old man who developed pulmonary tuberculosis 3 months prior was treated at another hospital before transferring to our institution. On admission, he had disturbance of consciousness. The eyes were found to be in the mid-position and fixed. He had no obvious limb paresis and sensory deficits. On day 5, Candida albicans was detected from blood culture, and vegetation was detected on the mitral valve using transesophageal echocardiogram. The patient was started on an antifungal agent for Candida albicans. On day 6, we obtained brain computed tomography (CT) scans and detected subcortical hemorrhage in the right frontal lobe. No intracranial aneurysm was found in CT angiography. On day 8, surgical removal of the hematoma was performed. On day 16, he suddenly suffered a cardiopulmonary arrest, and cardiopulmonary resuscitation was performed. Brain CT scan showed recurrent subcortical hemorrhage in the left frontal lobe. CT angiography showed a mycotic aneurysm at a branch of the left middle cerebral artery. Although we continued medical treatment, he died on day 79 after admission. In this case, a unique balloon-like aneurysm was formed, and it progressed rapidly for only 10 days. Time course of progression of candidial mycotic aneurysms is unknown. Zimmerman et al. reported a more rapid progression of candida infective endocarditis. Therefore, close observation and immediate management are needed for improving the prognosis for candida mycotic aneurysm. In addition, volume rendering images clearly revealed mycotic aneurysm. We suggest that constructing volume rendering images is suitable for detecting the formation of mycotic aneurysm.

Rapid progressive intracranial aneurysm resulting from candida infective endocarditis