October 24, 2011
A 32-year-old otherwise healthy man with recent history of military service at Bosnia-Herzegovina, where he suffered lumbar trauma, now presents with fever, backpain, and change in mental status.
CNS Pheohyphomycoses (Fungal Infection)
- Cerebral phaeohyphomycosis is a fungal infection of the brain typically caused by Cladophialophora bantiana, Exophiala dermatitidis (current case), and Rhinocladiella mackenziei, all of which belong to the order Chaetothyriales.
- The disease results in black, necrotic brain tissue, black pus, and black CSF.
- Pathogens usually reach the brain via the hematogenous route, and occasionally through direct spreading or accidental inoculation.
- Patients can present with hemiparesis, tonic spasm, headache, fever, sensory variation, cerebral irritation, and psychotic behavioral changes
- Key Diagnostic Features: Ring-like enhancing lesions representing granulomas or abscesses, with or without abnormal leptomeningeal enhancement, are seen.
- DDx: Abscesses, other granulomatous conditions, metastases
- Rx: Antifungal treatment, surgical debridement
