Cerebral phaeohyphomycosis: A rare case from central India

Abstract

Cerebral phaeohyphomycosis is a rare and frequently fatal disease, often caused by hematogenous spread of pathogens that are inoculated in the skin of the extremities following minor trauma, and its mortality rate is much high despite aggressive treatment. A rare case of 25-year-old immuno-competent man with cerebral abscess has been described. The etiological agent was microbiologically proved to be a dematiaceous fungi Cladophilaophora bantiana, which is primarily a neurotropic fungus causing deep-seated intra-cranial infections. Treatment was individualized by surgical intervention and appropriate anti-fungal therapy. Thus, it has been described as a successfully managed case of cerebral phaeohyphomycosis known to be associated with a high degree of morbidity and mortality.

Cerebral Phaeohyphomycosis: A Rare Case from South India

“…It is potentially fatal, if not promptly diagnosed and treated. The disease is most common in men similar to our case who was an immunocompetent man [4,8].…”

“…Most cases of cerebral phaeohyphomycosis occur as secondary infections following the development of infection in other sites, mainly paranasal sinuses. The species known to have a high neurotropic potential include Cladophialophora bantiana, Ramichloridium mackenziei, Ochroconis gallopavum, and Exophiala dermatitidis, out of which, Cladophialophora bantiana accounts for the majority of cases [4,8].…”

“…Aspergillosis, cryptococcosis, mucormycosis, and candidiasis are among the most common ones [2,3]. Even though the severe immunocompromised status is the most important risk factor for lifethreatening fungal infections, they are increasingly recognized in the immunocompetent as well [4].…”

“…These fungi are common soil inhabitant, true pathogens that are known for their neurotropism; however, central nervous system seeding may occur through hematogenous route, probably initiated by respiratory colonization consequent to inhalation or through inoculation in the skin of extremities following a slight or minor trauma. CNS phaeohyphomycosis presents with unusual features and is associated with poor prognosis without appropriate treatment [4].…”

Sticks and bones: Traumatic phaeohyphomycosis presenting as an epidural scalp abscess and cranial osteomyelitis

“…Cranial involvement is a rare manifestation and can be seen in greater proportion among immunocompetent individuals. Many infections occur hematogenously or can be spread as a result of sinusitis or a surgical procedure [5]. Local soft tissue extension to the cranial area is rare, given that traumatic inoculation to the head is poorly described in the literature and requires direct exposure of the scalp.…”