Fonsecaea pedrosoi cerebral phaeohyphomycosis ("chromoblastomycosis"): first human culture-proven case reported in Brazil

Abstract

SUMMARYCerebral phaeohyphomycosis ("chromoblastomycosis") is a rare intracranial lesion. We report the first human culture-proven case of brain abscesses due to Fonsecaea pedrosoi in Brazil. The patient, a 28 year-old immunocompetent white male, had ocular manifestations and a hypertensive intracranial syndrome. Magnetic resonance imaging (MRI) of the brain revealed a main tumoral mass involving the right temporo-occipital area and another smaller apparently healed lesion at the left occipital lobe. A cerebral biopsy was performed and the pathological report was cerebral chromoblastomycosis. The main lesion was enucleated surgically and culture of the necrotic and suppurative mass grew a fungus identified as Fonsecaea pedrosoi. The patient had received a knife wound sixteen years prior to his hospitalization and, more recently, manifested a pulmonary granulomatous lesion in the right lung with a single non-pigmented form of a fungus present. It was speculated that the fungus might have gained entrance to the host through the skin lesion, although a primary respiratory lesion was not excluded.The patient was discharged from the hospital still with ocular manifestations and on antimycotic therapy and was followed for eight months without disease recurrence. Few months after he had complications of the previous neuro-surgery and died. A complete autopsy was performed and no residual fungal disease was found.KEYWORDS: Phaeohyphomycosis; Cerebral "chromoblastomycosis"; Fonsecae pedrosoi; Brazil. CASE REPORTCase history -Patient: A 28 year-old white male, a rural worker, suffered in 1984 a knife wound in the right inguinal area when working in the woods which progressed to an abscess measuring approximately 2.0 x 0.5 cm in diameter. The patient was hospitalized and cultures of the material from the abscess were positive for Chromobacterium violaceum. No biopsy was obtained and no mycological study was done at the time. The patient received antibiotic treatment with healing of the skin lesion. At that time he noticed a visual defect in the left eye, which persisted to the end. He had epidemiological data for schistosomiasis and Chagas disease. The patient also referred an episode of icterus, fever and weakness one year prior to the clinical episode. Present history:In August 2000 the patient returned complaining of severe bitemporal headache accompanied by fits of dizziness with nausea and vomiting, right ocular pain and loss of the temporal field of the right eye.Examination showed a conscious young man, oriented, able to communicate well, with right papilledema and left optical disk atrophy. He had a right homonymous inferior quadrantopsy defect and a left homonymous hemianopsy. Isocoric pupils. Direct and consensual papillary reflex slow in the left eye and normal in the right eye. Near reflex normal in both eyes.Laboratory tests detected macrocytic anemia probably of nutritional origin. Serology for HIV, hepatitis B and C was negative.Lumbar tap, done few days after hospital admission showed essentially normal spin...

Fonsecaea pugnacius, a Novel Agent of Disseminated Chromoblastomycosis

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Melanized Fungi in Human Disease

“…Mortality was Ͼ70%. Since that review in 2004, over 50 cases have been reported, with C. bantiana remaining the most frequently seen isolate (131,4,17,16,22,31,40,70,78,93,121,139,170,189,243,244,268,272,276,328,332,341,363,380,399,420,433,448,450,467,476,545,575,636,657,696,700,721,731,733,754,759). A new species, Fonsecaea monophora, has been reported since that time and appears to have a predilection for causing CNS disease, in contrast to its related species, F. pedrosoi (420,721,733).…”

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