Revista Iberoamericana de Micología

Revista Iberoamericana de Micología

Volume 31, Issue 3, July–September 2014, Pages 203-206
Revista Iberoamericana de Micología

Note
Phaeohyphomycosis caused by Cladophialophora bantianaFeohifomicosis causada por Cladophialophora bantiana

https://doi.org/10.1016/j.riam.2013.05.004Get rights and content

Abstract

Background

Cladophialophora bantiana is the most frequent cause of central nervous system phaeohyphomycosis.

Aims

We report a case of phaeohyphomycosis by C. bantiana in a patient with underlying lung disease on steroid therapy.

Methods

An 81-year-old male was admitted in August 2011 with a history of difficulty speaking and deflection of the oral commeasure to the left side with a brain abscess. Brain tissue was cultured on Sabouraud media and sequence analysis of the internal transcribed spacer region of the ribosomal DNA was done for identification purposes. Susceptibility testing to various antifungal agents was performed using the microdilution test.

Results

Histopathological examination of the brain tissue ruled out malignancy and the presence of dematiaceous hyphae was observed. Culture showed the presence of a single black fungus, identified as C. bantiana. It was susceptible to all antifungals, except to caspofungin. The patient was treated with voriconazole plus liposomal amphotericin B. Cerebral cranial computed tomography [CCT] scans demonstrated persistence of the intraparenchymal abscess collection. Despite surgical and medical treatment with antifungal drugs, the patient died 5 months after the first diagnosis of the cerebral occupying lesion was made.

Conclusions

Phaeohyphomycosis is an uncommon infection with severe limitations on the clinical clues that can help in early diagnosis. Fungal species identification is mandatory for epidemiological and therapeutic reasons. The MICs could be useful in selecting the appropriate antifungal agent. Avoiding the unnecessary exposure to soil or other media potentially contaminated with fungal spores should be recommended to any immunosuppressed patient.

Resumen

Antecedentes

Cladophialophora bantiana es la causa más frecuente de feohifomicosis del sistema nervioso central.

Objetivos

Describimos un caso de feohifomicosis por C. bantiana en un paciente con una enfermedad pulmonar subyacente en tratamiento con corticosteroides.

Métodos

En agosto de 2011, ingresa un hombre de 81 años de edad con antecedentes de dificultad para hablar y desviación de la comisura bucal a la izquierda por un absceso cerebral. Se cultivó el aspirado del absceso cerebral en medio de Sabouraud y para la identificación definitiva del hongo se secuenció la región espaciadora transcrita interna del ADN ribosomal. Las pruebas de sensibilidad a los diferentes antifúngicos se efectuaron mediante microdilución.

Resultados

El examen histopatológico de las muestras descartó la presencia de un tumor maligno y confirmó la existencia de hifas. El cultivo reveló la presencia de un hongo dematiáceo identificado como Cladophialophora bantiana, sensible a todos los antifúngicos excepto a la caspofungina. El paciente fue tratado con voriconazol combinado con anfotericina B liposomal. La tomografía computarizada craneal mostró la persistencia del absceso intraparenquimatoso. A pesar del tratamiento con antifúngicos y del procedimiento quirúrgico, el paciente falleció 5 meses después de que se estableciera el diagnóstico inicial.

Conclusiones

La feohifomicosis es una infección poco frecuente, con importantes limitaciones de los indicios clínicos que pueden contribuir a un diagnóstico precoz. Por razones tanto epidemiológicas como terapéuticas, es indispensable la identificación de la especie de hongo responsable. La determinación de la concentración inhibitoria mínima podría ser de utilidad en la selección del tratamiento antifúngico apropiado. Los pacientes inmunodeprimidos deben evitar la exposición al suelo u otros medios potencialmente contaminados por esporas de hongos.

Section snippets

Case report

An 81-year-old male former smelting iron worker who was diagnosed with extrinsic allergic alveolitis and treated with corticosteroid tapering (prednisone 40 mg p.o. daily) was admitted in August 2011 with a history of difficulty in speaking and deflection of the mouth to the left side. Cerebral tomography revealed a space-occupying left frontal multinodular lesion with oedema, which was compatible with a brain abscess (Fig. 1). Thorax and cranial computed tomography ruled out any pulmonary

Discussion

Phaeohyphomycosis is an uncommon infection. Individual clinical case reports have been reported with limitations on the clinical clues that can help in early diagnosis. The data are not enough to make conclusive statements about therapy and outcomes, and it is hard to establish an incidence of this disease because it is not reportable and seems to occur sporadically.9, 15

Pathogenicity could be due to the presence of melanin in the cell wall, which is thought to confer a protective advantage by

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