Plant Fungus Gloeotinia SP: A Rare Finding in a Case of Mesial Temporal Sclerosis with Medical Refractory Epilepsy

Abstract

We report a case of a 38-year-old gentleman who diagnosed since the age of 11 with medical refractory epilepsy. Semiology began with symptoms of automatism followed by deviation of eyes and unpurposeful movement of left hand. Patient would then experience loss of consciousness and generalised tonic seizure involving all four limbs. These episodes tend to last for 1-2 minutes and post ictal drowsiness frequently follows. Electroencephalography (EEG) displayed findings compatible with right temporal epilepsy with secondary generalisation. Magnetic resonance imaging (MRI) of brain confirmed right hippocampal sclerosis as culprit for the seizures while neuropsychological tests displayed poor memory. Otherwise, patient had no neurological deficit or any history of long-term infection. After a long history of anti-epileptic drug polypharmacy with poor control of seizures, surgical treatment was opted for. Right amygdala-hippocampectomy was performed by neurosurgeon which was uneventful. Histopathology of surgical specimen was reported as sections of neuronal loss, suggestive of sclerosis and diffuse fungal infiltration at brain surface and blood vessels. This was then confirmed as Gloeotinia sp. Via BLAST (basic local alignment search tool) method. Patient remains fit free after surgery.