A rare case of fatal cerebral phaeohyphomycosis caused by Cladophialophora bantiana in an immunocompetent individual in India

Document Type : Case report


1 Department of Microbiology, All India Institute of Medical Science, Rishikesh, Uttarakhand, India

2 Department of Laboratory Medicine, AIIMS, Delh

3 Department of Neurosurgery, All India Institute of Medical Science, Rishikesh, Uttarakhand, India


Background and Purpose: Herein, we describe a rare case of fatal cerebral phaeohyphomycosis by Cladophialophora bantiana in an immunocompetent individual without any underlying risk factors.
Case report: A 55-year-old female presented with a short history of fever for 1 month, as well as headache, sudden onset of right-sided upper and lower limb weakness, and loss of speech for 10 days. Contrast-enhanced magnetic resonance imaging scan revealed large, peripherally enhancing, well-defined, cystic, space-occupying, axial lesion in the left parietal lobe with a mass effect. The patient was subjected to craniotomy, and the drained pus revealed pigmented septate hyphae in potassium hydroxide mount examination, which was identified as Cladophialophora bantiana. The patient was started on amphotericin B and voriconazole. However, she developed acute respiratory infection leading to multi-organ failure and death on day 27 post-operation.
Conclusion: In the absence of comparative trials owing to the rarity of the disease, the radical resection of lesion, drainage of pus, and prolonged targeted antifungal therapy with close postoperative radiological surveillance are the therapeutic measures of choice for patients with brain abscess caused by phaeoid fungi.


1. Velasco J, Revankar S. CNS infections caused by brown-black fungi. J Fungi. 2019; 5(3):60.
2. Revankar S, Baddley J, Chen S, Kauffman C, Slavin M, Vazquez J, et al. A mycoses study group international prospective study of phaeohyphomycosis: an analysis of 99 proven/probable cases. Open Forum Infec Dis. 2017; 4(4):ofx200.
3. Revankar S, Sutton D, Rinaldi M. Primary central nervous system phaeohyphomycosis: a review of 101 cases. Clin Infect Dis. 2004; 38(2):206-16.
4. Kantarcioglu AS, Guarro J, Hoog SD, Apaydin H, Kiraz N. An updated comprehensive systematic review of Cladophialophora bantiana and analysis of epidemiology, clinical characteristics, and outcome of cerebral cases. Med Mycol. 2016; 55(6): 579-604.
5. Revankar S, Sutton D. Melanized fungi in human disease. Clin Microbiol Rev. 2010; 23(4):884-928.
6. Garzoni C, Markham L, Bijlenga P, Garbino J. Cladophialophora bantiana: a rare cause of fungal brain abscess. Clinical aspects and new therapeutic options. Med Mycol. 2008; 46(5):481-6.
7. Ajantha GS, Kulkarni RD. Cladophialophora bantiana, the neurotropic fungus – a mini review. Clin Diagn Res. 2011; 5:1301-6.
8. Kuan CS, Cham CY, Singh G, Yew SM, Tan YC, Chong PS, et al. Genomic analyses of Cladophialophora bantiana, a major cause of cerebral phaeohyphomycosis provides insight into its lifestyle, virulence and adaption in host. PloS One. 2016; 11(8):e0161008.
9. Howlett S, Sullivan T, Abdolrasouli A, Borman A, Johnson E, Lewis P, et al. A black mould death: a case of fatal cerebral phaeohyphomycosis caused by Cladophialophora bantiana. Med Mycol Case Rep. 2019; 24:23-6.
10. Chakrabarti A, Kaur H, Rudramurthy S, Appannanavar S, Patel A, Mukherjee K, et al. Brain abscess due to Cladophialophora bantiana: a review of 124 cases. Med Mycol. 2015; 54(2):111-9.
11. Gandham P. Cladophialophora bantiana. Int J Res Med Sci. 2012; 2(1):38-41.
12. Mamelak AN, Mampalam TJ, Obana WG, Rosenblum ML. Improved management of multiple brain abscesses: a combined surgical and medical approach. Neurosurgery. 1995; 36(1):76-85.
13. Dash C, Kumar A, Doddamani RS. Is complete excision the key to cure for Cladophialophora bantiana brain abscess? A review of literature. Neurol India. 2016; 64(5):1062-4.
14. Chowdhary A, Meis JF, Guarro J, De Hoog GS, Kathuria S, Arendrup MC, et al. European society of clinical microbiology and infectious diseases fungal infection study group; European confederation of medical Mycology. ESCMID and ECMM joint clinical guidelines for the diagnosis and management of systemic phaeohyphomycosis: diseases caused by black fungi. Clin Microbiol Infect. 2014; 20(Suppl 3):47-75.
15. Gopalakrishnan R, Sethuraman N, Madhumitha R, Sukhwani K, Bansal N, Poojary I, et al. Cladophialophora bantiana brain abscess: a report of two cases treated with voriconazole. Indian J Med Microbiol. 2017; 35(4):620-2.
16. Ahmad M, Jacobs D, Wu H, Wolk D, Kazmi S, Jaramillo C, et al. Cladophialophora Bantiana: a rare intracerebral fungal abscess-case series and review of literature. Surg J. 2017; 3(2):e62-8.
Volume 6, Issue 3
September 2020
Pages 69-72
  • Receive Date: 09 April 2020
  • Revise Date: 22 July 2020
  • Accept Date: 10 August 2020
  • First Publish Date: 01 September 2020