Phaeohyphomycotic brain abscess due to Ochroconis gallopavum in a patient with malignant lymphoma of a large cell type

Abstract

A 60-year-old man with a 9-year history of malignant lymphoma developed an initial pulmonary infection with Nocardia asteroides which later disseminated to the central nervous system with multiple brain abscesses. He was treated successfully with intravenous trimethoprim-sulfamethoxazole for 6 weeks. A follow-up computed tomography (CT) scan showed complete resolution of the abscesses. Two years later, he returned to the hospital with a 2-week history of confusion, loss of concentration, ataxia, and leaning to the left. A CT scan revealed an enhancing multiloculated complex right frontal lesion. Craniotomy revealed a large right frontal lobe abscess, which was totally resected. Histopathologic examination of the resected tissue revealed multiple, lightly pigmented, septate, branched hyphal elements typical of phaeohyphomycosis. The fungal isolate cultured from the tissue was a dematiaceous, thermotolerant fungus that was identified as Ochroconis gallopavum. Despite treatment with amphotericin B, flucytosine and fluconazole, the patient gradually deteriorated and died. This case represents the third fatal infection, the second from the southeastern United States, due to O. gallopavum.