{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,29]],"date-time":"2026-08-29T12:26:04Z","timestamp":1788006364035,"version":"build-2784847793"},"reference-count":28,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2026,1,11]],"date-time":"2026-01-11T00:00:00Z","timestamp":1768089600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background and Clinical Significance: Cerebral candidiasis (Candida albicans meningoencephalitis) is a rare but severe central nervous system (CNS) infection, usually associated with neurosurgical procedures or indwelling devices. Diagnosis is challenging due to frequent negativity of cerebrospinal fluid (CSF) cultures, and mortality remains high despite antifungal therapy. Case Presentation: We describe a 64-year-old woman who underwent retrosigmoid resection of a left vestibular schwannoma. The early postoperative course was complicated by fever, neurological deterioration, and hydrocephalus requiring external CSF drainage. Multiple lumbar punctures revealed inflammatory CSF profiles but persistently negative cultures. One month post-surgery, intraoperative samples from mastoid repair material grew Candida albicans, prompting antifungal therapy. Despite treatment, the patient experienced fluctuating neurological status and required multiple external ventricular drains. Three months after surgery, she clinically deteriorated and died. Autopsy showed diffuse meningeal thickening and purulent exudates at the brain base and posterior fossa. Histopathology confirmed chronic lympho-histiocytic meningitis with necrotizing foci containing Candida albicans. Conclusions: This case underscores the diagnostic and therapeutic challenges of post-neurosurgical Candida CNS infections. Repeatedly negative CSF cultures delayed diagnosis, emphasizing the value of ancillary tests such as \u03b2-d-glucan and molecular assays. Even with antifungal therapy, prognosis is poor. Autopsy remains essential for uncovering fatal healthcare-associated fungal infections and informing clinical vigilance and medico-legal assessment.<\/jats:p>","DOI":"10.3390\/diagnostics16020228","type":"journal-article","created":{"date-parts":[[2026,1,12]],"date-time":"2026-01-12T07:30:34Z","timestamp":1768203034000},"page":"228","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Candida albicans Meningoencephalitis After Vestibular Schwannoma Surgery: An Autopsy-Confirmed Case Report"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-8449-1803","authenticated-orcid":false,"given":"Jessika","family":"Camatti","sequence":"first","affiliation":[{"name":"Department of Medicine and Surgery, University of Parma, Via Universit\u00e0 12, 43121 Parma, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matteo","family":"Tudini","sequence":"additional","affiliation":[{"name":"Unit of Legal Medicine, Department of Medical and Surgical Sciences, University of Bologna, Via Irnerio 49, 40126 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4889-1944","authenticated-orcid":false,"given":"Maria Paola","family":"Bonasoni","sequence":"additional","affiliation":[{"name":"Unit of Legal Medicine, Department of Medical and Surgical Sciences, University of Bologna, Via Irnerio 49, 40126 Bologna, Italy"},{"name":"Pathology Unit, Azienda USL-IRCCS di Reggio Emilia, Via Amendola 2, 42122 Reggio Emilia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna Laura","family":"Santunione","sequence":"additional","affiliation":[{"name":"Unit of Legal Medicine, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Via Campi 287, 41125 Modena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8451-7212","authenticated-orcid":false,"given":"Rossana","family":"Cecchi","sequence":"additional","affiliation":[{"name":"Unit of Legal Medicine, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Via Campi 287, 41125 Modena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-2064-6523","authenticated-orcid":false,"given":"Erjon","family":"Radheshi","sequence":"additional","affiliation":[{"name":"Unit of Legal Medicine and Bioethics, Azienda USL-IRCCS di Reggio Emilia, Via Amendola 2, 42122 Reggio Emilia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6521-5887","authenticated-orcid":false,"given":"Edoardo","family":"Carretto","sequence":"additional","affiliation":[{"name":"Clinical Microbiology Laboratory, Azienda USL-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy"},{"name":"U.O.C. Microbiologia e Virologia Azienda Socio Sanitaria Territoriale \u201cPapa Giovanni XXIII\u201d, 24127 Bergamo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,1,11]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"443","DOI":"10.1007\/s15010-018-1152-2","article-title":"Neuroinfections caused by fungi","volume":"46","author":"Blaszkowska","year":"2018","journal-title":"Infection"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1347","DOI":"10.1007\/s00701-011-0990-9","article-title":"Candida infection of the central nervous system following neurosurgery: A 12-year review","volume":"153","author":"Stevens","year":"2011","journal-title":"Acta Neurochir."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"11362","DOI":"10.21037\/apm-21-2577","article-title":"Candida central nervous system infection after neurosurgery: A single-institution case series and literature review","volume":"10","author":"Chen","year":"2021","journal-title":"Ann. Palliat. Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"e148","DOI":"10.1017\/S0950268820001144","article-title":"Candida meningitis in neurosurgical patients: A single-institute study of nine cases over 7 years","volume":"148","author":"Chen","year":"2020","journal-title":"Epidemiol. Infect."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Xiao, H., Miao, Y., Liu, L., Feng, W., Liu, S., Guo, L., Guo, X., Chen, T., Hu, B., and Hu, H. (2022). Clinical characteristics of central nervous system candidiasis due to Candida albicans in children: A single-center experience. BMC Infect. Dis., 22.","DOI":"10.1186\/s12879-022-07924-z"},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Kuenzli, A.B., M\u00fcller, M.D., Z\u2019Graggen, W.J., Walti, L.N., Martin, Y., Lazarevic, V., Schrenzel, J., and Oberli, A. (2024). Case report: Chronic Candida albicans meningitis: A rare entity diagnosed by metagenomic next-generation sequencing. Front. Cell. Infect. Microbiol., 14.","DOI":"10.3389\/fcimb.2024.1322847"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1093\/cid\/ciu737","article-title":"Cerebrospinal fluid (1,3)-\u03b2-d-glucan in isolated Candida meningitis","volume":"60","author":"Lyons","year":"2015","journal-title":"Clin. Infect. Dis."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Camp, I., Spettel, K., and Willinger, B. (2020). Molecular methods for the diagnosis of invasive candidiasis. J. Fungi, 6.","DOI":"10.3390\/jof6030101"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1093\/jpids\/piv014","article-title":"(1\u21923)-\u03b2-d-Glucan in cerebrospinal fluid as a biomarker for Candida and Aspergillus infections of the central nervous system in pediatric patients","volume":"5","author":"Salvatore","year":"2016","journal-title":"J. Pediatr. Infect. Dis. Soc."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"myaf037","DOI":"10.1093\/mmy\/myaf037","article-title":"Optimization of cutoff values for (1\u21923)-\u03b2-d-glucan and galactomannan assays in cerebrospinal fluid for the diagnosis of non-cryptococcal fungal infections of the central nervous system","volume":"63","author":"Samaddar","year":"2025","journal-title":"Med. Mycol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1135","DOI":"10.1080\/14737159.2023.2267977","article-title":"An update on current and novel molecular diagnostics for the diagnosis of invasive fungal infections","volume":"23","author":"Jenks","year":"2023","journal-title":"Expert Rev. Mol. Diagn."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"e1","DOI":"10.1093\/cid\/civ933","article-title":"Clinical practice guideline for the management of candidiasis: 2016 update by the Infectious Diseases Society of America","volume":"62","author":"Pappas","year":"2016","journal-title":"Clin. Infect. Dis."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1569","DOI":"10.1093\/jac\/dkad139","article-title":"Invasive candidiasis: Current clinical challenges and unmet needs in adult populations","volume":"78","author":"Soriano","year":"2023","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"ofz081","DOI":"10.1093\/ofid\/ofz081","article-title":"A retrospective forensic review of unexpected infectious deaths","volume":"6","author":"Sehgal","year":"2019","journal-title":"Open Forum Infect. Dis."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"18026","DOI":"10.1038\/nrdp.2018.26","article-title":"Invasive candidiasis","volume":"4","author":"Pappas","year":"2018","journal-title":"Nat. Rev. Dis. Primers"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1016\/S0732-8893(00)00140-1","article-title":"The central nervous system and infection by Candida species","volume":"37","author":"Corral","year":"2000","journal-title":"Diagn. Microbiol. Infect. Dis."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Nett, J.E., and Andes, D.R. (2020). Contributions of the biofilm matrix to Candida pathogenesis. J. Fungi, 6.","DOI":"10.3390\/jof6010021"},{"key":"ref_18","first-page":"1","article-title":"Gas gangrene, not a common infection: Case report of post-traumatic fulminant death","volume":"173","author":"Baldari","year":"2022","journal-title":"Clin. Ter."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1093\/clinids\/21.2.323","article-title":"Meningitis caused by Candida species: An emerging problem in neurosurgical patients","volume":"21","author":"Nguyen","year":"1995","journal-title":"Clin. Infect. Dis."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1285","DOI":"10.1128\/JCM.00061-13","article-title":"Cerebrospinal fluid (1,3)-\u03b2-d-glucan detection as an aid for diagnosis of iatrogenic fungal meningitis","volume":"51","author":"Lyons","year":"2013","journal-title":"J. Clin. Microbiol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"711","DOI":"10.1093\/cid\/ciad274","article-title":"\u03b2-d-Glucan assay in the cerebrospinal fluid for the diagnosis of non-cryptococcal fungal infection of the central nervous system: A retrospective multicentric analysis and a comprehensive review of the literature","volume":"77","author":"Bigot","year":"2023","journal-title":"Clin. Infect. Dis."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1186\/s41935-024-00401-5","article-title":"Is it time for a guideline on the use of immunohistochemistry in forensic pathology?","volume":"14","author":"Lancia","year":"2024","journal-title":"Egypt J. Forensic Sci."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"102508","DOI":"10.1016\/j.legalmed.2024.102508","article-title":"HIF-1\u03b1 expression by immunohistochemistry and mRNA-210 levels by real time polymerase chain reaction in post-mortem cardiac tissues: A pilot study","volume":"71","author":"Cecchi","year":"2024","journal-title":"Leg. Med."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1985","DOI":"10.1007\/s00414-024-03243-x","article-title":"Expression of matrix metalloproteinase-9 (MMP-9) in human skin within 1 hour after injury through immunohistochemical staining: A pilot study","volume":"138","author":"Cecchi","year":"2024","journal-title":"Int. J. Legal Med."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1141","DOI":"10.1007\/s00414-025-03461-x","article-title":"The current state of forensic imaging\u2014Post mortem imaging","volume":"139","author":"Dedouit","year":"2025","journal-title":"Int. J. Legal Med."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1177\/0025802420923175","article-title":"Diagnosing coronary thrombosis using multiphase post-mortem CT angiography (MPMCTA): A case study","volume":"61","author":"Jessika","year":"2021","journal-title":"Med. Sci. Law"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"200620","DOI":"10.1016\/j.fri.2024.200620","article-title":"Correlation between epicardial fat volume and postmortem radiological and autopsy findings in cases of sudden death: A pilot study","volume":"40","author":"Camatti","year":"2025","journal-title":"Forensic Imaging"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"200610","DOI":"10.1016\/j.fri.2024.200610","article-title":"Predictive value of coronary artery calcium score on radiological and autoptic findings in cases of sudden death","volume":"39","author":"Camatti","year":"2024","journal-title":"Forensic Imaging"}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/2\/228\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,12]],"date-time":"2026-01-12T07:41:28Z","timestamp":1768203688000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/2\/228"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,11]]},"references-count":28,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2026,1]]}},"alternative-id":["diagnostics16020228"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics16020228","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,11]]}}}