# Remarkable recovery from a Cladophialophora bantiana fungal brain abscess in an immunocompromised patient: a case report

## TL;DR

A rare case of a fungal brain abscess caused by Cladophialophora bantiana in an immunocompromised patient was successfully treated with antifungal therapy without further surgery.

## Contribution

This case report provides evidence that dual antifungal therapy can achieve stability in C. bantiana brain abscesses without complete surgical resection.

## Key findings

- A 68-year-old immunocompromised patient was diagnosed with a C. bantiana brain abscess.
- Dual antifungal therapy achieved clinical stability without additional surgery.
- The patient returned to pre-infection baselines 18 months post-diagnosis.

## Abstract

Cladophialophora bantiana is a globally distributed dematiaceous mold which acts as an uncommon source of human infection. With a predilection for the central nervous system (CNS), this organism accounts for nearly half of all cerebral phaeohyphomycosis, with a mortality rate over 60%. Due to the rarity of this disease, treatment regimens are primarily based on retrospective reviews of case reports. The best clinical response occurred with a dual approach of surgical resection and antifungal therapy, though mortality rates remain high.

A 68-year-old immunocompromised woman presented with imaging findings concerning for a neoplastic process, such as a glial neoplasm or CNS lymphoma. With microbiology, flow cytometry, and cytology of the cerebrospinal fluid negative and frozen section of the lesion favoring glial neoplasm, the scarce pigmented fungal hyphae on permanent sections were unexpected. Broad-range fungal DNA testing identified the organism as C. bantiana. Without further surgical resection, dual antifungal therapy was utilized to achieve clinical stability and return to pre-infection baselines.

This is a rare case of a C. bantiana fungal brain abscess in an immunocompromised patient. Complete surgical resection was not possible; however, this case provides additional data to show the benefits of a dual antifungal treatment approach without additional surgical intervention, and the dosages used to achieve stability at 18 months post-presentation. This case highlights the importance of prompt efforts in determining causative organisms in unexpected fungal brain abscesses, which allows for targeted and improved success in the treatment of this highly fatal disease.