Cerebral granuloma and meningitis caused by Candida albicans: useful monitoring of mannan antigen in cerebrospinal fluid.

The authors report the case of a previously healthy patient who had recurrent cerebral granulomas and meningitis caused by Candida albicans 15 years after the first onset. A combination of external drainage of cerebrospinal fluid (CSF) and intraventricular and intravenous chemotherapy with antifungal agents resulted in a favorable outcome. Investigation of this patient revealed no immunological dysfunction, lymphoproliferative disorder, or candidicidal defect of peripheral blood leukocytes. Sequential measurement of Candida mannan antigen in CSF was useful for establishing the early diagnosis of cerebral candidiasis and for judging the effect of our antifungal chemotherapy. In determining the surgical indications and timing of placement of a ventriculoperitoneal or ventriculoatrial shunt for meningitis subsequent to hydrocephalus after candidal infection, it is better to confirm normal concentrations of the mannan antigen in the CSF repeatedly for more than a week and to determine that cultures of the CSF are negative for Candida albicans.