A fatal case of systemic Acrophialophora sp. infection: The first autopsy case report

Acrophialophora spp., especially Acrophialophora fusispora, is a dematiaceous fungus that rarely infects humans, except in some fulminant cases of immunocompromised conditions with lesions in the brain and lungs. Herein, we aimed to report a general autopsy case of systemic Acrophialophora sp. infection with central nervous system involvement in a patient with hematological malignancy and Parkinson's disease. Blood tests and imaging suggested a systemic fungal infection; however, owing to the patient's critical condition, sampling the infectious tissue for culture was impossible, and blood cultures did not detect any microorganisms. Empirical treatment with antibacterial and antifungal drugs failed to save the patient. For pathological investigation, microbiological and histological examinations were performed during general autopsy. Microbiological examination of the brain tissue identified the pathogenic microorganism Acrophialophora sp. based on genetic analysis, showing the closest match to Acrophialophora fusispora. Histological examination of the infectious tissues revealed the angioinvasive potential of this pathogenic strain. To the best of our knowledge, this report is the first of a pathogenic microorganism identified as Acrophialophora sp. during a general autopsy. Our case provides histopathological evidence that Acrophialophora sp., like other molds, exhibits strong vascular invasiveness; however, identifying it through blood cultures is clinically challenging. Our case demonstrates that histopathological analysis can provide important information for fungal infection and highlights issues that should be addressed to overcome this rare and difficult-to-treat infectious disease, including the importance of aggressive tissue sampling to obtain a definitive diagnosis.