Cerebral phaeohyphomycosis caused by Fonsecaea pedrosoi in Saudi Arabia

A case of cerebral phaeohyphomycosis (CPM) in a 70-yr-old Saudi male was diagnosed recently at King Khalid University Hospital in Riyadh. Computerized tomography (CT) scans of the patient's brain unveiled 2 abscesses in the left frontal and a 3rd abscess in the right frontal lobes. Aspirated pus from the abscesses contained branched, septate, brown hyphae diagnostic of CPM. Culturing of pus yielded a slow-growing, dematiaceous fungus which was identified as Fonsecaea pedrosoi. Combined therapy of amphotericin B and 5-fluorocytosine had little or no effect as the patient continued to have spiking fever and his condition remained more or less unchanged. Medical care of the patient was unfortunately discontinued as he was discharged, with a rather poor prognosis, at the insistence of his family and against medical advice. Prior to this case, work had been done on identifying the agents responsible for two previously diagnosed cases of CPM in Saudi patients with fatal outcome. The dematiaceous fungi that were isolated remained sterile for quite a time before we succeeded in inducing sporulation. Both these isolates were also identified as being Fonsecaea pedrosoi.