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Cladophialophora bantiana Brain Abscess in an Immunocompetent Host: A Diagnostic Challenge
Rahul Kumar1, Pooja Khosla2, Vinus Taneja3
1DNB Trainee, Department of Internal Medicine, Sir Ganga Ram Hospital, New Delhi, Delhi, India, Orcid: https://orcid.org/0009-0005-5247-0113, Corresponding Author.
Abstract:
Cladophialophora bantiana has been identified as one of the most common causes of cerebral pheohyphomycosis. While intrafungal cerebral abscesses are historically known to be associated with immunocompromised patients, C. bantiana has a specific predilection for immunocompetent hosts. Successful treatment is based on accurate microbiological and histopathological diagnosis as well as the initiation of targeted antifungal treatment. We hereby report a case of a 64-year-old male who presented with atypical chest pain for 1 day, pain in both lower limbs, and blackish discoloration of the left foot. He also had left foot drop for 1 month. During his hospital stay, he developed a lower respiratory tract infection, was diagnosed with polycythemia vera, and later developed severe headache and dizziness. He was found to have a space-occupying lesion in the cerebellum and a pulmonary nodule. He was started on antitubercular therapy based on a lung biopsy suggestive of necrotizing granulomatous inflammation. However, the patient's sensorium kept worsening, and he was intubated. The fever persisted, and he had episodes of upper and lower gastrointestinal (GI) bleed. His sensorium continued to worsen. Autoimmune and immunodeficiency workups were inconclusive. Repeat imaging suggested an increase in the size of the lesions. Suboccipital craniectomy was performed and showed the growth of C. bantiana.
Insights
Cladophialophora bantiana can cause brain infections, even in healthy individuals. This case highlights the importance of diagnosing this fungus for effective antifungal treatment.
Area of Science:
- Mycology
- Neurology
- Infectious Diseases
Background:
- Cerebral pheohyphomycosis is typically seen in immunocompromised individuals.
- Cladophialophora bantiana (C. bantiana) uniquely affects immunocompetent hosts.
- Accurate diagnosis and targeted antifungal therapy are crucial for successful treatment.
Purpose of the Study:
- To report a rare case of Cladophialophora bantiana causing cerebral abscess.
- To emphasize the diagnostic challenges and treatment considerations for C. bantiana infections.
Main Methods:
- Case report of a 64-year-old male with complex symptoms.
- Diagnostic workup included imaging (CT/MRI), lung biopsy, and microbiological analysis.
- Surgical intervention (suboccipital craniectomy) for diagnosis and potential treatment.
Main Results:
- Patient presented with diverse symptoms including chest pain, lower limb pain, foot drop, respiratory infection, and neurological deficits.
- Initial diagnosis was complicated, leading to antitubercular therapy.
- Cerebellar lesion and pulmonary nodule were identified.
- Suboccipital craniectomy confirmed the presence of Cladophialophora bantiana.
Conclusions:
- Cladophialophora bantiana can cause severe neurological disease, even in immunocompetent individuals.
- This case underscores the need for considering fungal etiologies in complex, unexplained neurological conditions.
- Prompt microbiological diagnosis is essential for initiating appropriate antifungal treatment and improving patient outcomes.
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