Cerebral Phaeohyphomycosis: A Rare Case from South India

Abstract

Background and Importance: Cerebral phaeohyphomycosis is a rare but frequently fatal clinical entity caused by dematiaceous fungi like Cladophialophora bantiana. Fungal brain abscess often presents with subtle clinical symptoms and signs, and present diagnostic dilemma due to its imaging appearance that may be indistinguishable from other intracranial space-occupying lesions. Still, certain imaging patterns on Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) help to narrow down the differential diagnosis and initiate prompt treatment of these infections. Case Presentation: A 48-year-old immunocompetent man presented with right-sided hemiparesis and hemisensory loss and a provisional diagnosis of stroke was made. The radiological evaluation suggested the possibility of a cerebral abscess. Accordingly, surgical excision of the lesion was performed and the histopathological examination of the specimen revealed the etiology as phaeohyphomycosis. The patient was further treated with antifungals and discharged when general conditions improved. Conclusion: Fungal Central Nervous System (CNS) infections present diagnostic challenges and should be considered while interpreting ring-enhancing CNS lesions in immunocompetent patients. Surgical resection and antifungal treatment should be considered in all patients with cerebral phaeohyphomycosis.

Molecular Characterisation of Cladophialophora species Isolated from Brain Abscess in a Renal Transplant Recipient

“…Fungal brain abscess is a rare condition accounting for just 2% of the brain abscesses, mostly seen in immunocompromised hosts, while Aspergillus, Cryptococcus, Zygomycetes and Candida being the most common agents [10][11][12]. Nowadays they are increasingly recognized in immunocompetent hosts as well [13].…”

“…Cladophialophora is a true pathogen owing to its neurotropism and can cause primary central nervous system infections, whereas more than half of the patients are immunocompetent males [9,10]. Immunocompromised group include those with corticosteroid therapy, diabetes mellitus, neutropenia, intravenous drug abuse, bone marrow and solid organ transplantation [3,4,20].…”

“…Brain abscesses caused by C. bantiana have been reported in both immunocompetent and immunocompromised patients, while more than half of the cases are seen in immunocompetent males [3,9]. It poses a diagnostic dilemma due to non specific clinical presentation, neuroimaging findings mimicking a space occupying lesion and relative rarity of this condition, causing a delay in diagnosis which results in fatal outcome inspite of aggressive surgical and antifungal therapy [9][10][11]. Laboratory-based investigations play a vital role in the diagnosis and management of such dreadful infections [11].…”