Brain abscesses caused by Cladophialophora bantiana in a lung transplant patient: A case report and review of the literature

Abstract

Cladophialophora bantiana brain abscesses are rare, but are frequently and quickly lethal in transplanted patients. We report the case of a 63-year-old man who had undergone lung transplantation for chronic obstructive pulmonary disease and presented with headaches and a neurological deficit. Magnetic resonance imaging revealed multiple brain abscesses. C. bantiana was identified by DNA sequencing performed directly on cerebral tissue obtained by surgical biopsy. After 6 months of antifungal treatment, the brain abscesses were replaced by ischemic sequelae. The patient died suddenly 2 months later from a pulmonary bacterial infection. This is the second reported case of C. bantiana brain abscesses in a lung transplant recipient, to our knowledge, who experienced a long survival period with medical antifungal treatment alone. We review the literature and discuss our treatment.

Utility of liquid biopsy in diagnosing isolated cerebral phaeohyphomycosis: illustrative case

“… 1 Highly neurotropic, C. bantiana is a rare but recognized cause of intracranial abscess, with just 32 cases reported in North America between 1952 and 2014, mostly in immunocompetent male patients. 2 , 3 In immunocompromised patients, particularly recipients of solid organ transplant, C. bantiana brain infections have been increasingly reported 4 , 5 and may have a mortality rate as high as 80% because of poor responses to empirical antifungal monotherapy, the presence of multiple abscesses, and delays in establishing the diagnosis, which generally requires brain biopsy. Treatment is largely unsuccessful without complete excision of all abscesses via craniotomy.…”