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Case report
Cerebral protothecosis mimicking high-grade glioma
  1. James Samarasekara1,
  2. Soumya Mukherjee2,
  3. Azzam Ismail3 and
  4. Robert Corns4
  1. 1Department of Neurosurgery, Queen's Hospital, Romford, London, UK
  2. 2Department of Neurosurgery, King's College Hospital, London, UK
  3. 3Department of Pathology, Leeds Teaching Hospitals, Leeds, UK
  4. 4Department of Neurosurgery, Leeds General Infirmary, Leeds, UK
  1. Correspondence to Dr Soumya Mukherjee; soumya1701{at}


Prototheca wickerhamii is a common, indolent alga that seldom causes central nervous system infections in humans. We report the first UK case of cerebral protothecosis in an immunocompetent 56-year-old woman who presented with a 5-month history of intermittent fatigue followed by a 2-week history of symptoms, including right arm and leg weakness, a loss of fine motor coordination, worsening gait, right facial tingling, diplopia and a metallic oral taste. MRI scans revealed a multifocal abnormality suggestive of high-grade glioma. Given the clinical presentation, absence of immunodeficiency and characteristic MRI features, a diagnosis of high-grade glioma was deemed most likely by the multidisciplinary team. Surgical biopsy provided material for histopathological and microbiological diagnosis. She underwent a 2-year course of antimicrobials with surveillance MRI scans. The patient made a good functional recovery but still retains mild neurological sequelae.

  • infection (neurology)
  • neurosurgery
  • radiology
  • infectious diseases

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  • Contributors JS was responsible for the data collection, literature review, formatting of images and manuscript creation. SM was responsible for the surgical biopsy, concept of the manuscript and critical review of the final manuscript. AI was responsible for the histological analysis and diagnosis, providing and editing the histological images and providing critical review of the final manuscript. RC was responsible for the initial investigation and management, responsible for the surgical biopsies and for providing critical review of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.