278. CNS Blastomycosis: A Descriptive Analysis and Review of Diagnosis and Treatment

Background Blastomycosis is a systemic infection, well known to regions of the Southeastern and Ohio River Basin in the United States. Inhalation of the dimorphic fungus most often causes pulmonary manifestations. Hematogenous dissemination can affect various organs in immunocompromised hosts. Central Nervous System (CNS) involvement is a rare manifestation of Blastomycosis infection, accounting for 5%–10% of extrapulmonary involvement. It is important to diagnosis early and treat due to the increased morbidity in high-risk patients. Methods Our study retrospectively reviewed cases from a Tertiary Care Facility in East Tennessee from 2011 to 2018 with the diagnosis of CNS Blastomycosis. Data collection included demographics, risk factors, varied clinical presentation, methods of diagnosis, treatment plans and outcomes. Results Total of 8 CNS Blastomycosis cases were identified. Detailed demographics are presented in Table 1. The average age was 52 years, 7 (87.5%) were male. 6 (75%) were classified as immunocompromised. 6 of the 8 cases were tested for HIV, all of which were negative. MRI brain imaging was utilized in 7 (87.5%) cases, which demonstrated lesion enhancements, Table 2 and Images 1 and 2. CSF was collected in 6 (75%) patients. 5 patients (62%) presented with neurological complaints. All patients received Liposomal Amphotericin B (LAmpB), followed by a prolonged course of azoles. 5 (62%) developed acute renal insufficiency after starting Amphotericin B. 2 (25%) died. Conclusion CNS Blastomycosis is a rare diagnosis with increased morbidity and mortality. Obtaining brain imaging in addition to lumbar puncture can help in timely diagnosis of CNS Blastomycosis. Treatment involves lipid formulation of Amphotericin B followed by oral azole therapy, preferably voriconazole. Renal insufficiency was a common finding after this treatment. A high level of suspicion is crucial for recognition of CNS Blastomycosis in endemic regions of the Southeastern and Ohio River Basin. Disclosures All authors: No reported disclosures.