Cerebral Phaeohyphomycosis due to Cladophialophora bantiana – A Case Report and Review of Literature from India Keywords: Cerebral phaeohyphomycosis, Cladophialophora bantiana, Multiple brain abscesses, Voriconazole

Cerebral phaeohyphomycosis is a rare disease caused by dematiaceous fungi. It has poor prognosis irrespective of the immune status of the patient. Cladophialophora bantiana is the most commonly isolated species. We report a case of multiple brain abscesses caused by C. bantiana in an immune competent patient. The diagnosis was based on CT scan of head, direct examination and culture of the aspirate from the abscess. Despite complete surgical resection of the abscesses and antifungal therapy with amphotericin B and voriconazole the patient could not be saved. All the cases of cerebral phaeohyphomycosis due to this rare neurotropic fungus reported from India between 1962 and 2009 have also been reviewed. [Table/Fig-5]: CT scan showing post-operative changes and cerebral oedema [Table/Fig-1]: CT Scan of head showing multiple ring enhancing lesions with midline shift and diffuse edema [Table/Fig-2]: KOH mount of the aspirate showing brown, septate fungal hyphae (x400) [Table/Fig-3]: Sabouraud’s Dextrose Agar (SDA) showing olive grey to black velvety growth of C bantiana [Table/Fig-4]: LCB mount showing brown septate hyphae with unbranched wavy chains of pale brown smooth one celled conidia (x400) Pooja Suri et al., Cerebral Phaeohyphomycosis due to Cladophialophora bantiana – A Case Report and Review of Literature from India www.jcdr.net Journal of Clinical and Diagnostic Research. 2014 Apr, Vol-8(4): DD01-DC05 2 Case no. reference & ref. no. age, Sex occupation Clinical Presentation risk Factor radiological findings and Positive microbiological/ Pathological findings Therapy outcome 1 Bagchi et al., 1962 Calcutta [3] 54y, M Not known Fever-2 mths, Lt* hemiplegia 6 wks, followed by headache, vomiting, seizures 3 attacks in 3 wks None EEGSOL†, HPE‡ Total excision Expired 2 Sandhyamani et al.,1981 Delhi [4] 50y, M Not known Headache5 yrs, focal seizuresn -3 yrs, Lt hemiperesis – 2 yrs 6 months, Fever2 mth, altered sensorium None CTwell defined paraventricular mass in Rt§ basal ganglia, Culture, HPE Partial excision, no antifungal agent given Not Known 3 Sandhyamani et al., 1981 Delhi [4] 6 months, M Not known Seizure and fever-1 wk, None CTmultilocular abscess in frontal lobe, Repeat CT after 1 monthhydrocephalous, HPE Partial excision, VP shunt after 1 month, no antifungal agent given Survived, on follow up for 10 mths 4 Banerjee et al., 1989 Delhi [5] 28y, M Rice merchant Headache 8mths, seizures 2 attacks, blurred vision 1 mth None CT-Lt frontal SOL, Gram stain, KOH mount, culture, HPE Total excision, Amphotericin B, Survived 5 Goel et al., 1992 Bombay [6] 36y, M Not Known Symptoms of raised ICT None CTRt parietal SOL, HPE, culture Total excision, Ketoconazole, Amphotricin B Recurrence after 2 mths, Expired 6 Dar et al., 1993 Delhi [7] 16y, M Student Headache & fever-17 days None CTLt fronto-parietal SOL, KOH mount, culture Near total excision , Amphotericin B Recurrence after 5 wks, Not known 7 Nadkarni et al.,1993 Bombay [8] 32y, M Not known Convulsions 1 mth, bitemporal headache, hemiperesis, aphasia and altered sensorium after 1 wk None CTmultiple ring enhancing lesions in parieto occipital region, KOH smear, culture, HPE Parieto occipital craniotomy with excision, Amhotericin B (Liposomal) Expired after 20 days