An Unusual Cause of Cerebellitis in an Immunosuppressed Elderly Man: Disseminated Scedosporium boydii Following Gardening-Related Injury.

Scedosporium boydii is an uncommon but increasingly recognized cause of opportunistic infections, particularly in immunocompromised individuals. We describe the case of a 92-year-old man on long-term corticosteroids who presented with progressive gait instability, confusion, and posterior headache. Initial neuroimaging revealed parietal-occipital and cerebellar lesions, raising concerns for malignancy or infarction. Although corticosteroid therapy initially provided temporary symptom relief, the patient subsequently deteriorated. Skin changes consistent with cellulitis were developed in the upper limb, and rapid progression of neurological lesions on repeat imaging, findings more suggestive of an infectious rather than a malignant process. Cultures from the skin lesion grew S. boydii, prompting the initiation of voriconazole and flucytosine. Despite appropriate antifungal therapy, the patient's condition worsened, culminating in multiorgan failure and death. Retrospective history revealed a fall in a muddy garden, suggesting direct cutaneous inoculation as the source of infection, an atypical presentation since most cases are associated with near-drowning incidents. This case highlights the diagnostic challenges posed by rare fungal central nervous system infections that mimic more common intracranial pathologies and underscores the importance of early tissue sampling and multidisciplinary collaboration in managing such complex cases.