Cladophialaphora bantianum brain abscess: a case report.

Cladophialaphora bantianum is a dematiaceous fungus with dark pigmented hyphae that is a rare cause of central nervous system infection. We report the case of a 74-year-old immunocompromised individual who presented to the emergency room with complaint of left-sided weakness. Physical examination revealed a chronically ill appearing man with motor and sensory deficit of the left upper and lower extremities. MRI of the brain revealed multiple ring-enhancing cerebral lesions, the largest measuring 4.6 X 3.9 centimeters within the parietal region. Stereotactic needle biopsy revealed a pigmented fungus and cultures of aspirated fluid grew C bantiana. The patient was initially treated with liposomal amphotericin B and later received additional voriconazole and 5-flucytosine when he did not improve. Repeat MRI 1 month into therapy revealed no significant interval change, and surgical resection of the largest lesion was performed. Despite surgery and adjunctive antifungal therapy, the patient continued to deteriorate and therapy was withheld per family request. C bantianum is an aggressive mold associated with poor clinical responses to antifungal therapy. Optimal management involves aggressive surgical and adjunctive antifungal therapies.

Anuradha Tunuguntla, MD, Mustafa Saad, MD, and James W. Myers, MD. Department of Internal Medicine and Department of Infectious Diseases, East Tennessee State University, Johnson City, TN. Department of Infectious Diseases, Johnson City Medical Center, Johnson City, TN.