First autochthonous case of Rhinocladiella mackenziei cerebral abscess outside the Middle East

Abstract

Cerebral phaeohyphomycosis due to Rhinocladiella mackenziei is a severe infection in the middle east, resulting in nearly 100% mortality despite the application of combined surgical and antifungal therapy and occurring occasionally in otherwise healthy patients. We report the first case of brain infection in a middle-aged male in India, where R. mackenziei is not endemic.

FIG. 1.

(A and B) Initial CT scans showing a discrete, large (approximately 5- to 6-cm-diameter), irregular, peripheral ring-enhancing necrotic mass lesion in the right frontoparietal region with mass effects and midline shift with perifocal edema. (C) Third CT scan showing a decrease in lesion size (to around 4 cm) but increasing parietal edema, enlargement of mass effects, and multiple, coalescing, ring-enhancing cerebral lesions.

FIG. 2.

(A and B) Hematoxylin and eosin staining revealed necrosis with dense and diffuse mixed inflammatory infiltrates, granuloma formation, and the presence of numerous septate hyphae (arrows) surrounded by a dense inflammatory response. (C) Biopsy specimens were also stained with Ziehl-Neelsen stain, which revealed many moniliform, branched, septated hyphal elements.

FIG. 3.

R. mackenziei (CBS 125089). (A) Colony on MEA (Difco) at 30°C after 2 weeks in darkness. (B and C) Semimicronematous conidiophores and sympodially proliferating conidiogenous cells (arrow). Scale bars, 10 μm.