Journal of Medical Cases, ISSN 1923-4155 print, 1923-4163 online, Open Access
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Case Report

Volume 8, Number 11, November 2017, pages 351-355

Successful Treatment of Cerebral Pheohyphomycosis Caused by Cladophialophora bantiana Infection in a Solid Organ Transplant Patient: A Case Report and a Review of Literature

Figures

Figure 1.
Figure 1. Magnetic resonance imaging (MRI), sagittal view. There is a 2.0 cm lobulated ring-enhancing right cerebellar mass with central restricted diffusion consistent with abscess. There is significant edema, mass effect and compression of the fourth ventricle.
Figure 2.
Figure 2. MRI, sagittal view. There is a 1.6 × 1.8 cm ring-enhancing right cerebellar mass with extensive surrounding vasogenic edema and compression of the fourth ventricle.
Figure 3.
Figure 3. Lactophenol cotton blue preparation demonstrated pigmented septate hyphae.
Figure 4.
Figure 4. Sheep red blood agar plate grew mucoid dark pigmented colonies.
Figure 5.
Figure 5. Sabouraud agar plate grew mucoid dark pigmented colonies.

Table

Table 1. Review of Literature of Cladophialophora Infection in Solid Organ Transplant Patients [21-29]
 
ReferenceAgeGenderOrgan transplantedImmunosuppressantPresentationLocationCladophialophoraManagementOutcome
C. bantiana: Cladophialophora bantiana; C. trichoides: Cladophialophora trichoides; CT: computed tomography; CMV: cytomegalovirus; E. coli: Escherichia coli.
[21]50MLiver-Confusion, left hemiparesis, lethargy and slurred speech progressing to comaRight temporoparietalC. trichoidesInoperableExpired 7 days after diagnosis
[22]25FKidneyPrednisolone, azathioprine, cyclosporineGeneralized seizures, right hemiparesisLeft parietalUnspecified pheohyphomycosisCT-guided stereotactic aspiration, amphotericinExpired 1 month after aspiration from fulminant hepatitis from hepatitis C and B, and a CMV infection leading to sepsis
[22]51MKidneyPrednisolone, azathioprineOne episode of generalized seizure, headache and vomiting for 10 daysLeft parietalUnspecified pheohyphomycosisCT-guided stereotactic aspiration, liposomal amphotericin, craniotomy with abscess excisionCured
[23]6MLiver-Right-sided focal seizuresLeft frontal lobeC. bantianaAspiration, amphotericin, craniotomy with abscess excisionCured
[24]35MKidneyPrednisolone, cyclosporine, azathioprineTwo episodes of generalized tonic clonic seizures over 4 months, headache and vomiting for 1 monthRight parietalC. trichoidesExcision, amphotericin BCured
[25]57-HeartPrednisolone, azathioprine, FK 506, anti-T lymphocyte globulinNausea and ataxiaRight cerebellarC. bantianaStereotactic aspiration, surgical excision, initially amphotericin B and 5-fluorcytosin, was switched to itraconazoleAbscess recurrence with spread and fatal septic shock
[26]41FHeart, lungMycophenolate mofetil, tacrolimus, prednisoneRight facial numbness, right upper molar tooth pain, right earache, diplopia, and right frontotemporal headacheRight cerebellarC. bantianaCraniotomy with abscess excision, liposomal amphotericin B, voriconazole, recurrence with repeat craniotomyExpired 45 days after presentation
[27]30FHeartMethotrexate, tacrolimus, mycophenolate mofetilPresented 5 weeks after beginning treatment for lung infection with headachesLeft cingulate gyrusUnspecified CladophialophoraFungal pneumonia was tx with amphotericin B lipid complex, but was switched to liposomal amphotericin B after brain abscess diagnosed, excisional biopsy, then switched to itraconazoleExpired about 4 months after cerebral abscess identified
[28]36FKidneyCyclosporine, azathioprine, prednisoloneFrontal headaches and left arm weaknessThree separate lesions in unspecified locations within white matterC. bantianaStereotactic guided biopsy, liposomal amphotericin B, flucytosine, itraconazole with reduction of prednisolone and discontinuation of azathioprineWas still being treated 12 months out with itraconazole and flucytosine, CT scan showed regression with mild inflammation remaining
[29]61MKidneyCyclosporine, azathioprine, prednisoneRight hemiparesisLeft parietotemporalC. bantianaCraniotomy with abscess excision, fluconazole, dexamethasone, recurrence treated with another craniotomy/excision, amphotericin B and fluconazoleDeveloped septic shock from E. coli and expired 1 month and 12 days after initial diagnosis
Our case60MLungCyclosporine, azathioprine, prednisoneGait instability, headaches, photophobiaRight cerebellarC. bantianaStealth directed resection/liposomal amphotericin B
voriconazole		Cured