Cerebral Phaeohyphomycosis in a Patient with Neurosarcoidosis on Chronic Steroid Therapy Secondary to Recreational Marijuana Usage

Abstract

Cerebral phaeohyphomycosis is often a fatal disease that typically takes a hematogenous spread after inhalation or accidental skin inoculation of pathogens. We present a patient with a history of heavy marijuana smoking while being on chronic steroid therapy for treatment of neurosarcoidosis who was found to have multiple brain abscesses from Curvularia sp. This is a ubiquitous soil-dwelling dematiaceous fungus that is generally thought to affect solely plants, but there is increasing evidence in the literature of it affecting humans and animals. We review the radiographic findings of neurosarcoidosis and cerebral phaeohyphomycosis as well as the pathophysiology of dematiaceous fungi infections.

Cerebral Phaeohyphomycosis : A Rare Cause of Brain Abscess

“…Hemiparesis and headache are the most common symptoms followed by various clinical manifestations 17) . About 70-80% of cases typically manifest as a single brain abscess particularly on the frontal lobe (52%) like in our case, while multiple brain abscesses can be seen in immunocompromised patients 3 , 6 , 17 , 19) .…”

“…CP is a rare infection caused by darkly pigmented fungi, namely dematiaceous fungi 23) . Dematiaceous fungi represent a group of filamentous molds that contain melanin pigment in their cell walls 3 , 6 , 14 , 17) . Cladophialophora bantiana is the most frequently isolated species.…”

“…Even though immunodeficiency may play a role as a risk factor, there are many reports of this infection in immunocompetent individuals similar to the patient in this report 12 , 15 , 17 , 19 , 25) . The portal entry to brain is unclear, although several possible routes have been suggested, such as hematogenous dissemination of inhaled spores or accidental skin inoculation as well as direct extension from adjacent paranasal sinuses or ears 2 , 6 , 10 , 14 , 15 , 19 , 22 , 23) . The authors were unable to ascertain the route of infection in the present case.…”

Phaeohyphomycosis: Infection Due to Dark (Dematiaceous) Molds

“…Exposure is thought to be from inhalation or minor trauma, which may not even be noticed by the patient. Anecdotal reports suggest that smoking may be a risk factor in patients who are immunodeficient [8]. Surveys of outdoor air for fungal spores routinely observe dematiaceous fungi [9].…”

“…The pathogenesis may be hematogenous spread from an initial, presumably subclinical pulmonary focus. However, other risk factors such as chronic sinusitis or smoking have been implicated in case reports [8,36]. It remains unclear why these fungi preferentially cause central nervous disease (CNS) disease.…”