A fatal case of cerebral scedosporiosis caused by Scedosporium boydii in a kidney transplant recipient: A case report and literature review

Invasive opportunistic fungal infections are rare but devastating complications in solid organ transplant recipients, often associated with delayed diagnosis and high mortality. Among these, infections caused by Scedosporium species pose significant therapeutic challenges due to intrinsic antifungal resistance. We report a fatal case of cerebral scedosporiosis caused by Scedosporium boydii in a 52-year-old kidney transplant recipient with systemic lupus erythematosus. Following augmented immunosuppression therapy for suspected acute rejection, the patient developed persistent fever, neurological deterioration, and seizures. Neuroimaging revealed a hemorrhagic periventricular brain lesion, and the diagnosis was confirmed by mycological culture and internal transcribed spacer sequencing. Despite antifungal therapy with liposomal amphotericin B and neurosurgical intervention, the patient died. This case highlights the fulminant course of central nervous system scedosporiosis, the diagnostic challenges in transplant recipients, and the limited efficacy of the current treatment options.