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Chaetomium sp. is a mold, member of the phylum Ascomycota. Clinical disease in humans is rare, particularly in children, for which only five cases have been reported. We report a 7-months-old female patient with a diagnosis of visceral heterotaxy syndrome who was admitted to a private center in Mexico. After two episodes of focal myoclonic seizure, a brain magnetic resonance imaging (MRI) revealed a right porencephalic cyst and a right frontal abscess with ventriculitis. Seventy-two hours after temporal abscesses drainage procedure, the culture showed a rapidly growing pale white fungal colony. Sequencing of internal transcribed spacer (ITS) and D1/D2 led to the identification of Chaetomium strumarium. Although Chaetomium sp. is a rare fungal infection in humans, clinicians should consider it as a plausible etiologic agent that can form brain abscess.

An elderly man presented with right homonymous hemianopia and gait instability. He was found to have a left occipital ring enhancing lesion that was resected. Neuropathologic examination demonstrated a Cladophialophora bantiana brain abscess (cerebral phaeohyphomycosis).

Cerebral phaeohyphomycosis refers to central nervous system infection caused by dematiaceous molds, which have many genuses. Cladophialophora bantiana is a member of the phylum ascomycota, which is found in soil samples from all over the world. This organism typically infects immunocompromised patients and associated with 70% mortality rate even after weeks of antifungal agent administration and surgical debridement. Two such cases of fungal brain abscess caused by cladophialophora bantiana were presented here. Both patients presented with complaints of headache, vomiting, drowsiness and impaired cognition. A brain biopsy together with microbiological culture and VITEK 2 helped in reaching to a final diagnosis. Key Words: Cladophialophora bantiana, Dematiaceous, Intracerebral, Phaeohyphomycosis.

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.

Cerebral phaeohyphomycosis is infection of the central nervous system (CNS) caused by dematiaceous fungi. The most common mechanisms of infection are by direct extension from the paranasal sinuses or by hematogenous spread. The mortality rate is high and ranges from 50%–79% in the limited studies on this infection. Our case describes a young man without any preexisting disease who acquired cerebral phaeohyphomycosis following nasal inhalation of garden mushrooms. Despite aggressive treatment, he ultimately died due to this severe infection. Our case report discusses our treatment approach and reviews the literature on this deadly infection. Keywords: fungal infection, cerebral abscess, Bipolaris, phaeohyphomycosis

Background Fungal brain abscesses in immunocompetent patients are exceedingly rare. Cladophialophora bantiana is the most common cause of cerebral phaeohyphomycosis, a dematiaceous mold. Radiological presentation can mimic other disease states, with diagnosis through surgical aspiration and growth of melanized fungi in culture. Exposure is often unknown, with delayed presentation and diagnosis. Case presentation We present a case of cerebral phaeohyphomycosis in a 24-year-old with no underlying conditions or risk factors for disease. He developed upper respiratory symptoms, fevers, and headaches over the course of 2 months. On admission, he underwent brain MRI which demonstrated three parietotemporal rim-enhancing lesions. Stereotactic aspiration revealed a dematiaceous mold on staining and the patient was treated with liposomal amphotericin B, 5-flucytosine, and posaconazole prior to culture confirmation. He ultimately required surgical excision of the brain abscesses and prolonged course of antifungal therapy, with clinical improvement. Conclusions Culture remains the gold standard for diagnosis of infection. Distinct microbiologic findings can aid in identification and guide antimicrobial therapy. While little guidance exists on treatment, patients have had favorable outcomes with surgery and combination antifungal therapy. In improving awareness, clinicians may accurately diagnose disease and initiate appropriate therapy in a more timely manner.

We report this rare case of cerebral phaeohyphomycosis in a previously healthy Chinese boy, who was found to have caspase recruitment domain family member 9 (CARD9) deficiency. Initial radiological features suggested a neoplastic cerebral lesion, while histopathological examination supplemented by internal transcribed sequencing (ITS) of cerebral tissue confirmed the diagnosis of phaeohyphomycosis. He was treated with intravenous (IV) liposomal amphotericin B and voriconazole, guided by plasma and cerebrospinal fluid (CSF) level monitoring at drug initiation. At the 1 year follow-up, the patient demonstrated near complete neurological and radiological recovery.

Cerebral phaeohyphomycosis is a rare and fatal fungal infection of the central nervous system (CNS) caused by dematiaceous fungi. The aim of this study was to analyse the clinico- radiological presentation, pathology and outcome of cerebral phaeohyphomycosis and discuss the relevant literature.Data of 7 patients diagnosed with cerebral phaeohyphomycosis and managed at our institute between 2014 and 2020 was collected and reviewed retrospectively. The diagnosis was established after surgery on KOH mount, Sabouraud dextrose agar, frozen section or histopathology. The clinical, radiological and pathological characteristics along with outcomes were analysed.Three patients with underlying comorbidities [chronic renal failure-2 and haematological malignancy -1] presented with brain abscess. The remaining 4 had no comorbidities. Two of them mimicked cystic glioma and one patient presented as intraventricular tumour. Another patient on anti- tubercular treatment for suspected pulmonary tuberculosis presented with encephalitis. Histopathology in all patients showed diffuse micro abscesses with coarse and reactive gliosis in the adjacent brain parenchyma and chronic lymphomononuclear inflammation without angioinvasion or vasculitis. Four showed granuloma formation. Antifungals were started after diagnosis. Six out of seven patients died and one was lost to follow up.Cerebral phaeohyphomycosis presents as abscesses in immunocompromised patients and mimics tumours in immunocompetent patients. KOH mount and frozen section examination is simple yet effective tool for establishing early diagnosis. Overall, the prognosis is dismal. Administering antifungals early in the course of management along with aggressive surgical excision may improve outcomes.

Rhinocladiella mackenziei cerebral phaeohyphomycosis is a rare severe disease that has been typically described in the Middle East. Here, we report 2 cases of R. mackenziei cerebral phaeohyphomycosis in patients from Morocco, diagnosed and treated in France, and raise a concern about the ever-going extension of the area at risk for this devastating invasive fungal infection.

Phaeohyphomycosis is a group of infections caused by pigmented, black, dematiaceous fungi and is responsible for cutaneous, superficial and deep mycoses, disseminated infection and brain abscesses. The primary agents involved include Alternaria spp., Exophiala spp. and Cladophialophora spp. Invasive systemic presentation is rare and in most cases is associated with immunosuppression; for this reason, reported cases of Alternaria spp. infection are scarce. This report describes the case of a 66-year-old man with a history of renal transplantation from a cadaveric donor 1 year ago, which was considered as the primary risk factor. The characteristics of the infection, procedures performed, microbiological findings and treatment provided are described. Keywords: Alternaria, Brain abscess, Phaeohyphomycosis, Transplant

Cladophialophora bantiana is a neurotropic mould and primary cause of cerebral phaeohyphomycoses, which presents with brain abscesses in both immunocompromised and immunocompetent individuals. It is associated with high mortality due to delay in diagnosis and absence of standardised therapy. We present a case of fatal cerebral phaeohyphomycosis in a 67-year-old Caucasian man. Diagnosis was achieved by histopathological examination of brain tissue followed by conventional culture and molecular identification. We highlight diagnostic and treatment challenges involved. Keywords: Cerebral phaeohyphomycoses, Dematiaceous fungi, Gene sequencing, Cladophialophora bantiana

Background and Purpose: Rhinocladiella mackenziei is a neurotropic fungus, which can cause devastating intracerebral infections with up to 100% fatality rate. It is difficult to isolate this fungus in laboratory as it grows slowly and requires diagnostic skills. Case report: A 42-year-old Pakistani man presented with headache, facial numbness, progressive upper limb weakness, and dysarthria. Magnetic resonance imaging of thebrain showed a space-occupying lesion in the basal ganglia region. The patient underwent supratentorial craniotomy for biopsy and excision. Histopathology of the specimen revealed granulomatous inflammation with abscess formation. Periodic acidSchiff special stains highlighted the presence of numerous septate fungal hyphae. The results revealed the growth of dematiaceous fungi, which were morphologically classified as R. mackenziei. The patient is currently stable and is being on amphotericin and posaconazole, along with neurorehabilitation therapy. Conclusion: Rhinocladiella mackenziei brain abscess is a devastating infection with significant mortality. This condition should be suspected in patients with brain abscessfrom high endemic areas

Background and Purpose: Fungal infections of the central nervous system (CNS) are life-threatening conditions that are frequently misdiagnosed with bacterial and viral CNS infections. Cerebral phaeohyphomycosis is a cerebral infection caused by dematiaceous fungi, especially Cladophialophora bantiana. Very few cases of fungal CNS infection have been reported across the world. High clinical suspicion should be cast for the patients with brain abscess that do not respond to conventional antibiotic therapy.Case report: We report a case of a 21-year-old male presenting with headache, seizures and weakness in the limbs. Radiological examination revealed multiple brain abscesses. After surgical excision and laboratory evaluation, it was found to be caused by C. bantiana. The patient’s outcome was good with surgical excision and voriconazole therapy. Conclusion: Brain abscess caused by C. bantiana is on rise, especially in immunocompromised groups. Thus, high clinical suspicion, accurate diagnosis and management are the fundamentals for good prognosis.

Background Cladophialophora species are fungi, which almost exclusively cause infections of the central nervous system. Mortality from Cladophialophora exceeds 65% despite treatment. Although it is a rare infection in the United States, the use of multiple and concurrent immunosuppressants has led to surges in invasive fungal infections. Case Presentation We present a case of cerebral phaeohyphomycosis caused by Cladophialophora bantiana in a patient with multiple sclerosis and rheumatoid arthritis, who was treated with fingolimod and methotrexate. The patient presented with altered mental status and aphasia secondary to a loculated abscess in the left temporal region. She underwent surgical debridement and was treated with antifungals. Fingolimod and methotrexate were discontinued indefinitely, and the patient recovered. Conclusion Fingolimod, a lymphocyte-depleting agent, increases the risk of opportunistic infections, especially if used concurrently with other disease modifying therapies, therefore, careful selection of a single agent should be performed in patients with MS and other concurrent autoimmune disorders.

Primary cerebral phaeohyphomycosis due to Rhinocladiella mackenziei is an extremely rare infection carrying more than 80% mortality, with most cases reported from the Middle East region. This darkly pigmented black yeast is highly neurotropic, aggressive and refractory to most antifungal agents. Here we present an immunocompetent elderly male, presenting with multiple brain abscesses, with R. mackenziei confirmed by nuclear ribosomal repeat region sequencing, who was successfully treated by surgical debridement and intravenous voriconazole. To our knowledge this is the first case reported from the United Kingdom. We also present a review of all such cases so far reported in the English literature world-wide, which we believe is a step further to understanding the pathogenesis and establishing effective treatment of this rare, yet often fatal disease.

Casestudy: Phaeohyphomycosis is a group of infections caused by pigmented, black, dematiaceous fungi and is responsible for cutaneous, superficial and deep mycoses, disseminated infection and brain abscesses. The primary agents involved include Alternaria spp., Exophiala spp. and Cladophialophora spp. Cerebral phaeohyphomycosis is particularly devastating with mortality rates as high as 70-80%. These fungi are becoming increasingly important opportunistic pathogens in solid organ transplant recipients (SOTR). We report a case of cerebral phaeohyphomycosis in a 65-year-old male with living donor kidney transplant for four years and has been maintained on immunosuppressive therapy with tacrolimus and prednisone. The patient presented with aphasia, frontal headache, loss of peripheral vision of right eye, and mental status change for three months due to several left- sided parieto-occipital brain abscesses. Left occipital abscess resection and parietal partial lobectomy were performed to reduce intracranial hypertension and to remove abscesses. Histopathological evaluation revealed brain abscess with pigmented fungal organisms with elongated, branched and septate. The pus aspirated during surgical excision of brain lesions grew black mold, identified as Cladophialophora bantiana. The patient’s neurological neurological condition had imporved after several weeks of combination antifungal therapy with posaconazole, liposomal amphotericin, and flucytosine. The lesions were initially suspected to be of tuberculous etiology, which was ruled out by histopathological examination. Such diagnostic dilemmas are common in the infection caused by Cladophialophora, which can cause treatment delay and death. Early diagnosis is therefore mandatory for the rapid treatment and survival of patients. As the number of SOTR increases, so does the incidence of fungal infections in that population. Surgery, along with antifungal therapy and a reduction in immunosuppression, are the cornerstones of treatment.

Cerebral phaeohyphomycosis (CP), caused by dematiaceous fungi, is a serious form of central nervous system fungal infection. It is a rare disease with male predominance, no specific symptoms or signs and is associated with grim prognosis irrespective of the immune status of the patient. The disease is difficult to diagnose antemortem, and many cases are accidentally diagnosed during surgery or autopsy. The early diagnosis and appropriate treatment remain a challenge. The authors report a misinterpreted case of CP in a 53-year-old man without immunodeficiency who showed a favorable outcome after surgical excision and antifungal therapy. Therefore, CP should be an important differential in cases of brain abscess.

Exophiala dermatitidis, a dematiaceous fungus typically found in decaying organic matter worldwide, is a rare cause of fungal infections. Cerebral phaeohyphomycosis is a sporadic but often fatal infection of the brain caused by E. dermatitidis. However, due to limited reports, little is known about its specific predisposing factors, clinical manifestation, and optimal treatment modality. Here, we report a clinical presentation and management of cerebral phaeohyphomycosis in a Chinese patient. An otherwise healthy, young male who was diagnosed with neck fungal lymphadenitis caused by E. dermatitidis 7 months prior and was treated with itraconazole, presented later with progressive intracranial hypertension and persistent coma. Culture of the neck lymphoid tissue produced growth of a black yeast-like fungus, which was identified as E. dermatitidis by sequencing of the ribosomal DNA internal transcribed spacer (ITS) domains. Accordingly, a cerebral biopsy was performed, and the pathological report showed mycelia and fungal granulomas. We also sequenced CARD9 in the patient and found him to be homozygous for loss-of-function mutation; his parents were heterozygous for the same mutation. This is a first case report of cerebral phaeohyphomycosis caused by E. dermatitidis in a CARD9-deficient Chinese patient. He eventually succumbed to brain herniation and severe lung infection with a poor response to therapy. Thus, previously healthy patients with unexplained invasive E. dermatitidis infection, at any age, should be tested for inherited CARD9 deficiency.

Posaconazole diffusion has been documented in various organs, which contrasts with the scarce data available for the human central nervous system (CNS). We analyzed posaconazole concentrations in plasma and multiple CNS specimens taken from a patient who received posaconazole because of cerebral phaeohyphomycosis. Low posaconazole concentrations were obtained in CNS specimens, with sample-to-plasma ratios between 5% and 22%. This case highlights the role of neurosurgery during cerebral phaeohyphomycoses, even those caused by posaconazole-susceptible black fungi.

Cerebral phaeohyphomycosis is a rare but serious fungal infection of the central nervous system caused by dematiaceous septate fungi characterized by the presence of melanin-like pigment within the cell wall that is a pale brown to black. It is associated with poor prognosis despite aggressive treatment. We report a previously well 3-year boy with cerebral phaeohyphomycosis who had subacute meningoencephalitic presentation with refractory raised intracranial pressure and had fatal outcomes. The diagnosis was confirmed by histopathological examination of brain tissue obtained by brain biopsy.

Fungal infections are infrequent causes of brain abscesses. Fonsecaea monophora is a dematiaceous fungus that appears to be neurotropic. We report a case of Fonsecaea monophora infection in a patient with acquired immunodeficiency syndrome, and review previous reports of brain abscesses by this organism.

We report a case of cerebral phaeohyphomycosis, a fungal brain infection due to a dark (dematiaceous) fungi in a 6-year-old French Guyanese boy. The child presented fever and drowsiness due to several paraventricular brain abscesses. Neurological surgeries were performed to reduce intracranial hypertension and to obtain abscess biopsies. Mycological cultures of intraoperative samples led to the diagnosis of cerebral phaeohyphomycosis due to Cladophialophora bantiana. The patient neurological status deteriorated and remained critical after several weeks of combination antifungal therapy with voriconazole 8 mg/kg/day, liposomal amphotericin B 10 mg/kg/day and flucytosine 200 mg/kg/day. A complete surgical resection was not possible because of multiple small abscesses. A multidisciplinary ethical staff decided on home medical care with palliative ventriculoperitoneal shunt, nasogastric feeding and analgesics. One year later, the patient's neurological condition had improved and cerebral lesions had regressed, while he had not received any antifungal treatment but only traditional medicines. Cerebral phaeohyphomycosis are rare diseases affecting immunocompromised but also apparently non-immunocompromised patients, as in this case. A complete surgical resection is not always possible and mortality rates are high in spite of treatments with a combination of antifungals. The diagnosis may be difficult because of these dematiaceous fungi's slowly growing and their potential pathogenicity for laboratory staff.

We present a case of brain abscess in an immunocompetent child due to the dematiaceous fungus Microascus cinereus, an organism commonly found in soil and stored grains. The etiologic agent was demonstrated by direct microscopy and culture. The patient responded well to surgical excision of abscess along with a course of amphotericin B and voriconazole. Microascus species have emerged as significant invasive pathogens especially in the immunocompromised patients. To the best of our knowledge, this is the first reported case of brain abscess caused by M. cinereus in an immunocompetent individual with no underlying risk factors.

Cerebral feohifomycosis are severe infections caused by dematiaceous fungi. Cladophialophora bantiana is one of the most commonly isolated species; it has central nervous system tropism and it often manifests as a brain abscess in immunocompetent patients. In immunocompromised patients, it can lead to brain abscesses and disseminated infections. Despite the availability of broad-spectrum antifungal drugs, it is a must to perform surgical management, in addition to drug therapy. However, mortality is high. The diagnostic approach must be invasive to establish a timely diagnosis and direct treatment based on culture and susceptibility tests. We report a case of brain abscess caused by C. bantiana in an immunosuppressed patient who was treated with surgical resection and voriconazole with an adequate response to therapy and without neurological sequels.Las feohifomicosis cerebrales son infecciones graves causadas por mohos dematiáceos, entre los cuales Cladophialophora bantiana es una de las especies más comúnmente aislada. Esta tiene tropismo por el sistema nervioso central y frecuentemente produce abscesos cerebrales en pacientes inmunocompetentes; además, en los inmunocomprometidos también puede ocasionar infección diseminada. Pese a la disponibilidad de medicamentos antifúngicos de amplio espectro, a menudo se requiere también la intervención quirúrgica; de todas maneras, la mortalidad es elevada. El diagnóstico debe hacerse interviniendo para tomar la muestra y hacer el cultivo y las pruebas de sensibilidad. Se presenta aquí el caso de un paciente con trasplante renal que presentó un absceso cerebral por C. bantiana, el cual se extrajo mediante resección quirúrgica. El paciente recibió tratamiento con voriconazol, con adecuada respuesta, mejoría y sin secuelas neurológicas.

Item does not contain fulltext Cerebral phaeohyphomycosis is frequently a fatal disease caused by truly neurotropic dematiaceous fungi. Although rare, this infection occurs especially among immunocompetent patients, and the clinical symptoms are often misdiagnosed as a cerebral tumour or bacterial brain abscess. The appropriate diagnosis and therapy of cerebral infections by melanized fungi are very challenging if they are caused by mysterious fungi with unknown ecological niche. We reported the second case of cerebral phaeohyphomycosis due to Rhinocladiella mackenziei in Iran and the first culture-confirmed case. In this report, the differential diagnosis and histopathological findings are discussed and a review of the literature is provided.

We present an unusual equine endometritis case associated with Cladophialophora bantiana in a 15-year-old mare. The mare displayed infertility and uterine fluid accumulation with numerous black, hairy granules. Microscopically, the fluid revealed numerous septate, dark fungal hyphae and conidia in chains. Culture yielded C. bantiana (CBS 138271); the species was confirmed by internal transcribed spacer (ITS) sequencing. Treatment was unsuccessful. C. bantiana causes cerebral phaeohyphomycosis in humans, while animal cases are rare. Animal cases are reviewed.

The Fonsecaea species, which are the leading causes of chromoblastomycosis, are not considered neurotropic fungal agents. Fonsecaea pedrosoi is the primary species in the genus and is usually isolated from chromoblastomycosis cases. However, the recently distinguished species F. monophora has been reported in a few cerebral phaeohyphomycosis cases. Here, a case of cerebral phaeohyphomycosis caused by Fonsecaea monophora is presented in a 71-year-old female subject with chronic diabetes mellitus and hypertension. The identification of F. monophora was made through mycological and molecular analysis, and an isolate was differentiated from the closely related F. pedrosoi by sequence data on key bases on the ribosomal internal transcribed spacer region. The case was successfully treated with surgical and medical approaches, and the patient has remained healthy and stable after a ten-month follow up. Given the increasing incidence of this type of infection of the central nervous system (CNS), this case provides further support for the consideration that F. monophora might represent a neurotropic agent.

A draft genome sequence of type strain Fonsecaea multimorphosa CBS 980.96 T was obtained. This species was first isolated from a cat with cerebral phaeohyphomycosis in Queensland, Australia.

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.

© 2013 Japanese Society of Neuropathology. This is the peer reviewed version of the following article: Jelinek, A. G., Fuller, C., Baykal, A., Stogner-Underwood, K., Richard, H. and Arkun, K. (2014), Headaches and hemiparesis in an immunocompetent inmate. Neuropathology, 34: 314-317, which has been published in final form at doi: 10.1111/ neup.12084. This article may be used for non-commercial purposes in accordance With Wiley Terms and Conditions for self-archiving.

Phaeohyphomycosis is an increasingly recognized cause of brain abscess in both immunocompetent and immunocompromised hosts. We report a case of cerebral phaeohyphomycosis in a 55-year-old male heart transplant recipient caused by Bipolaris spicifera. We review the literature regarding the pathogenesis, epidemiology, diagnosis, and management of infections with dematiaceous fungi.

Six cases of Rhinocladiella mackenziei cerebral phaeohyphomycosis are being reported for the first time in Pakistan. Identification was confirmed by DNA sequencing (isolates and fixed tissue). Diabetes, head trauma, immunosuppressive treatment, and postpartum state were present in 4 cases. Two survivals and 3 fatalities occurred, with 1 patient lost to follow-up.

Cerebral phaeohyphomycosis due to Rhinocladiella mackenziei is a severe infection in the middle east, resulting in nearly 100% mortality despite the application of combined surgical and antifungal therapy and occurring occasionally in otherwise healthy patients. We report the first case of brain infection in a middle-aged male in India, where R. mackenziei is not endemic.

Summary. A 45-year-old woman was found to have cerebral phaeohyphomycosis caused by an Exophiala species. The portal of entry of the fungus remained unknown. Despite surgery and antimy-cotic therapy the patient died from circulation failure. The fungus is compared to several related Exophiala species. Zusammenfassung. Eine 45jahrige Frau er-krankte an einer zerebalen Phaeohyphomykose, hervorgerufen durch eine Exophiala-Art. Die Ein-trittspforte dieses Schwarzepilzes wurde nicht ge-funden. Trotz chirurgischer und antimykotischer Therapie starb die Patientin an Komplikationen des grosen Kreislaufs. Der Stamm wird mit einigen ver-wandten Exophiala-Arten verglichen.

The incidence of cerebral phaeohyphomycosis, an infection caused by a dark-pigmented fungus, is increasing. The infection may mimic a high-grade glioma clinically and radiographically. Magnetic resonance spectroscopy may be helpful in differentiating the two. We report two cases to increase the awareness of cerebral phaeohyphomycosis in the clinical neurosciences. Early biopsy establishing the diagnosis, followed by aggressive combined surgical and medical management is necessary for a good outcome.

We report a case of cerebral phaeohyphomycosis caused by Scytalidium dimidiatum (synanamorph Nattrassia mangiferae) in a young, apparently immunocompetent Indian male. Etiological diagnosis was made by recovery of the fungus in culture and histopathological examination. The infection proved fatal despite aggressive antifungal therapy.

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. Diagn. Cytopathol. 2007;35:695–699. ' 2007 Wiley-Liss, Inc.

Background: Phaeohyphomycosis refers to infections caused by phaeoid fungi that can have an aggressive course in normal hosts. Involvement of the central nervous system may occur with a generally poor outcome. Clinical report and literature review: We report a case of Bipolaris sp. brain abscess in an immunologically competent host. We also review all previous cases of cerebral phaeohyphomycosis in normal hosts reported in the literature to date. Conclusions: Central nervous system phaeohyphomycosis remains an unusual disease; however, its incidence has been increasing in recent years. The prognosis of this condition is still poor, despite medical and surgical interventions. Aggressive diagnostic approaches and careful interpretation of cultures might modify the natural history of this disease.

BACKGROUND Cerebral phaeohyphomycosis caused by Fonsecaea pedrosoi is a rarity. However, about four cases have been reported in the literature. The disease remains mostly fatal despite employment of new treatment modalities. CASE An 18-year-old boy presented seizures of recent onset. Two years back, he developed cutaneous phaeohyphomycosis after a splinter scratch on his chest wall. Imaging revealed a contrast enhancing parafalcian solid mass. Right frontal parasagittal craniotomy was performed and the lesion resected as much as possible, followed by IV amphotericin B and oral itraconazole treatment. The patient has been doing well during a 15-month follow-up period. DISCUSSION Cerebral phaeohyphomycosis is an extremely rare lesion, which could masquerade as a parafalcian mass. Radical surgical removal together with antimicrobials remains the cornerstone treatment of cerebral phaeohyphomycosis.

Cerebral phaeohyphomycosis is a rare and frequently fatal disease. We report a case of cerebral phaeohyphomycosis caused by Exophiala dermatitidis in a young immuno competent male presenting to a tertiary care hospital in Jaipur.