Phaeohyphomycosis caused by Cladophialophora bantiana

• Published in: Revista iberoamericana de micologia Vol. 31; no. 3; pp. 203 - 206
• Main Authors: Martínez-Lamas, Lucía, Álvarez, Maximiliano, Llovo, Jose, Gené, Josepa, Cano, José
• Format: Journal Article
• Language: English
• Published: Spain Elsevier Espana 01.07.2014
• Subjects: Aged, 80 and over; Antifungal Agents; Ascomycota; Cladophialophora bantiana; Feohifomicosis; Humans; Infectious Disease; Male; Phaeohyphomycosis; Phaeohyphomycosis - diagnosis; Phaeohyphomycosis - drug therapy; Phaeohyphomycosis - microbiology; Feohifomicosis; Phaeohyphomycosis; Cladophialophora bantiana
• ISSN: 1130-1406; 2173-9188
• DOI: 10.1016/j.riam.2013.05.004

Abstract Background Cladophialophora bantiana is the most frequent cause of central nervous system phaeohyphomycosis. Aims We report a case of phaeohyphomycosis by C. bantiana in a patient with underlying lung disease on steroid therapy. Methods An 81-year-old male was admitted in August 2011 with a history of difficulty speaking and deflection of the oral commeasure to the left side with a brain abscess. Brain tissue was cultured on Sabouraud media and sequence analysis of the internal transcribed spacer region of the ribosomal DNA was done for identification purposes. Susceptibility testing to various antifungal agents was performed using the microdilution test. Results Histopathological examination of the brain tissue ruled out malignancy and the presence of dematiaceous hyphae was observed. Culture showed the presence of a single black fungus, identified as C. bantiana . It was susceptible to all antifungals, except to caspofungin. The patient was treated with voriconazole plus liposomal amphotericin B. Cerebral cranial computed tomography [CCT] scans demonstrated persistence of the intraparenchymal abscess collection. Despite surgical and medical treatment with antifungal drugs, the patient died 5 months after the first diagnosis of the cerebral occupying lesion was made. Conclusions Phaeohyphomycosis is an uncommon infection with severe limitations on the clinical clues that can help in early diagnosis. Fungal species identification is mandatory for epidemiological and therapeutic reasons. The MICs could be useful in selecting the appropriate antifungal agent. Avoiding the unnecessary exposure to soil or other media potentially contaminated with fungal spores should be recommended to any immunosuppressed patient.