Indian Journal of Neurosurgery 2013; 02(02): 199-202
DOI: 10.4103/2277-9167.118130
Case Report
Thieme Medical and Scientific Publishers Private Ltd.

A rare case report of cerebral phaeohyphomycosis mimicking glioma in a patient of rheumatic valvular heart disease

Ashish Chugh
,
Sharada Rane
1   Pathology, B. J. Medical College and Sassoon General Hospitals, Pune, Maharashtra, India
,
Charandeep Singh Gandhoke
2   Surgery (Neurosurgery Unit), B. J. Medical College and Sassoon General Hospitals, Pune, Maharashtra, India
,
Kulkarni Maithili
1   Pathology, B. J. Medical College and Sassoon General Hospitals, Pune, Maharashtra, India
› Author Affiliations

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Further Information

Publication History

Publication Date:
18 January 2017 (online)

Abstract

Phaeohyphomycosis is a collective term used for fungal infections caused by moulds and yeasts that have brown pigmented cell walls due to the presence of melanin. These are also known as dematiaceous fungi. We report this patient who presented with headache, right hemiparesis, slurred speech, and altered sensorium. Patient was a known case of rheumatic valvular heart disease (RVHD) and had undergone balloon valvotomy for mitral stenosis 1 year back. Radiological features were suggestive of high grade glioma. Left fronto-parietal decompressive craniectomy with complete excision of mass lesion was performed. Histopathological examination of the surgical specimen revealed multiple granulomas with giant cells. These giant cells contained branched septate pigmented fungal hyphae in their cytoplasm. After the histopathology report, patient was started on intravenous amphotericin and was discharged on oral itraconazole 200 mg twice daily. Unfortunately, the patient was non-compliant and stopped taking oral itraconazole after 1 month. He landed up in fulminant fungal meningo-encephalitis and died 10 weeks after the initial diagnosis. We report a rare case of cerebral phaeohyphomycosis in a patient of RVHD which, to our knowledge, is nowhere mentioned in the literature.

 
  • References

  • 1 Ajello L, Georg LK, Steigbigel RT, Wang CJ. A case of phaeohyphomycosis caused by a new species of Phialophora. Mycologia 1974; 66: 490-498
  • 2 Osiyemi OO, Dowdy LM, Mallon SM, Cleary T. Cerebral phaeohyphomycosis due to a novel species: Report of a case and review of the literature. Transplantation 2001; 71: 1343-1346
  • 3 Jacobson ES. Pathogenic roles for fungal melanins. Clin Microbiol Rev 2000; 13: 708-717
  • 4 Sutton DA, Slifkin M, Yakulis R, Rinaldi MG. U.S. case report of cerebral phaeohyphomycosis caused by Ramichloridium obovoideum (R. mackenziei): Criteria for identification, therapy, and review of other known dematiaceous neurotropic taxa. J Clin Microbiol 1998; 36: 708-715
  • 5 Rajput DK, Mehrotra A, Srivastav AK, Kumar R, Rao R. Cerebral phaeohyphomycosis mimicking glioma. Pan Arab J Neurosurg 2011; 15: 87-90
  • 6 Raut A, Muzumdar D, Narlawar R, Nagar A, Ahmed N, Hira P. Cerebral abscess caused by Cladosporium bantianum infection - Case report. Neurol Med Chir (Tokyo) 2003; 43: 413-415
  • 7 Revankar SG, Sutton DA, Rinaldi MG. Primary central nervous system phaeohyphomycosis: A review of 101 cases. Clin Infect Dis 2004; 38: 206-216
  • 8 Garg N, Devi IB, Vajramani GV, Nagarathna S, Sampath S, Chandramouli BA. et al Central nervous system cladosporiosis: An account of ten culture-proven cases. Neurol India 2007; 55: 282-288
  • 9 Hiruma M, Kawada A, Ohata H, Ohnishi Y, Takahashi H, Yamazaki M. et al Systemic phaeohyphomycosis caused by Exophiala dermatitidis. Mycoses 1993; 36: 1-7
  • 10 Kwon-Chung KJ, Bennett JE. editors Phaeohyphomycosis. In: Medical Mycology. Philadelphia: Lea and Febiger; 1992. p 620-677