Aspiration cytology of brain abscess from a fatal case of cerebral phaeohyphomycosis due to Ramichloridium mackenziei

Abstract

Ramichloridium mackenziei is a dematiaceous fungus that usually causes cerebral phaeohyphomycosis. We describe the aspiration cytology findings of a case of cerebral abscess caused by R. mackenziei in a 66-yr-old Saudi woman who had a long standing history of diabetes mellitus and a recent diagnosis of systemic lupus erythematosus. She was on long-term corticosteroid therapy. The patient developed rapidly progressive multiple brain abscesses and died despite aspiration of the abscess and administration of intravenous amphotericin B lipid complex and voriconazole.

Cerebral Phaeohyphomycosis Caused by Rhinocladiella mackenziei in a Woman Native to Afghanistan

“…Based on the present description, it may be hypothesized that the latency may persist for years, as our patient had not returned to Afghanistan for 20 years. To the best of our knowledge, 21 other cases have been reported between 1983 and 2010 (3,4,5,8,9,13,14,17,19,21). The fungus affects adults with a median age of 62 years (range, 32 to 80 years), without male predominance.…”

Cerebral phaeohyphomycosis due to Rhinocladiella mackenziei (formerly Ramichloridium mackenziei): Case presentation and literature review

“…This infection has affected apparently immunocompetent and immunocompromised patients, with similarly dismal outcomes. Of the total reported cases, seven (25%) had no reported underlying conditions [9][10][11]14,18], five (18%) patients had diabetes mellitus [1,8,15,18] and four patients had solid organ transplant [3,10,18] (Table 1). The current patient had diabetes mellitus, a condition that is found in 18% of the reported cases.…”

“…Cerebral phaeohyphomycosis is an infection caused by dematiaceous fungi especially in immunocompromized patients [1][2][3]. Of the dematiaceous fungi known to be neurotrophic include Cladophialophora bantiana, Wangiella dermatitidis and Chaetomium atrobrunneum [4][5][6][7].…”

“…Of the dematiaceous fungi known to be neurotrophic include Cladophialophora bantiana, Wangiella dermatitidis and Chaetomium atrobrunneum [4][5][6][7]. In addition, Rhinocladiella mackenziei (formerly Ramichloridium mackenziei) has been reported to be a causative agent of fatal cases of R. mackenziei infection [1][2][3]. R. mackenziei infection appears to occur predominantly in the Middle East and to target the brain exclusively [1][2][3].…”

“…In addition, Rhinocladiella mackenziei (formerly Ramichloridium mackenziei) has been reported to be a causative agent of fatal cases of R. mackenziei infection [1][2][3]. R. mackenziei infection appears to occur predominantly in the Middle East and to target the brain exclusively [1][2][3]. However, it should be noted that R. mackenziei has not been recovered from any environmental source [3].…”