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Cerebral phaeohyphomycosis caused by Ramichloridium obovoideum (Ramichloridium mackenziei): case report
Y D Podnos1, P Anastasio, L De La Maza
1Department of Surgery, University of California, Irvine Medical Center, Orange 92868, USA.
Objective And Importance:
Only a few cerebral infections with the dark-walled mold Ramichloridium obovoideum (Ramichloridium mackenziei) have been reported in the literature. Central nervous system infections caused by this fungus have poor prognoses; the optimal medical and surgical treatments have not yet been established. We report a case of cerebral R. obovoideum infection for which a combination of medical and surgical treatments failed.
Clinical Presentation:
A 58-year-old Kuwaiti woman, with a history of chronic renal failure requiring hemodialysis, presented with a 3-day history of left frontal headache, blurry vision, dizziness, and right-sided clumsiness. Computed tomography demonstrated multiple, ring-enhancing, cerebral lesions (the largest of which measured 2-3 cm) in the deep left parieto-occipital region.
Intervention:
A computed tomography-guided needle biopsy of the parieto-occipital lesion yielded 10 ml of dark caseous fluid. Stains demonstrated long, branching, septate hyphae. Fungal cultures grew R. obovoideum. The patient was treated with a combination of amphotericin B and itraconazole. The condition of the patient continued to deteriorate, and stereotactic aspiration of the largest lesion was performed. Despite this approach, the lesion progressed and the patient died.
Conclusion:
R. obovoideum is being increasingly recognized as a cause of cerebral abscesses in patients residing in the Middle East. Prognoses are poor, and responses to antifungal therapy are generally short-lived. Until more effective therapies are found, the greatest chance for adequate treatment involves early recognition, prompt treatment with antifungal agents, and attempts at complete resection.
Insights
Ramichloridium obovoideum (Ramichloridium mackenziei) causes rare, aggressive cerebral abscesses. Despite aggressive medical and surgical interventions, this case resulted in patient mortality, highlighting the need for improved treatments.
Area of Science:
- Mycology
- Neurology
- Infectious Diseases
Background:
- Ramichloridium obovoideum (Ramichloridium mackenziei) is a rare fungus causing cerebral infections.
- Central nervous system infections by this mold have a poor prognosis, with no established optimal treatments.
Observation:
- A 58-year-old woman with chronic renal failure presented with neurological symptoms and multiple ring-enhancing cerebral lesions.
- Biopsy revealed dark caseous fluid and septate hyphae, with fungal cultures identifying R. obovoideum.
Findings:
- The patient received a combination of amphotericin B and itraconazole, followed by stereotactic aspiration.
- Despite interventions, the cerebral lesions progressed, leading to the patient's death.
Implications:
- R. obovoideum is increasingly recognized as a cause of cerebral abscesses, particularly in the Middle East.
- Current antifungal therapies show limited efficacy, necessitating early recognition and aggressive management, including complete resection.
- Further research into effective therapies for R. obovoideum cerebral infections is crucial.