Cladophialophora bantiana osteomyelitis in a renal transplant patient

Abstract

Cladophialophora bantiana is a neurotropic dematiaceous fungus which rarely causes disseminated disease. We report a case of proven C. bantiana osteomyelitis in a renal transplant recipient, complicated with probable cerebral disease. Stable disease was reached after combined antifungal therapies, immune enhancement and amputation of the infected lower limb.

Keywords: Cladophialophora bantiana; Immunocompromised; Osteomyelitis; Phaeohyphomycosis; Transplantation.

Fig. 1

T2 weighted brain magnetic resonance imaging shows bilateral diffuse thalamic abnormalities with edema in the internal capsules (a). Multiple confluent micronodules with small cystic components are seen on a gadolinium enhanced T1 weighted image (b). An area of diffusion restriction, indicated by arrows, is noted in the right thalamus on diffusion weighted imaging, reflecting the presence of pus (c,d).

Fig. 2

Hematoxylin-eosin stain of tibia bone biopsy (day +71). Granuloma with central hyphae and giant cells, surrounded by mononuclear inflammatory cells. Hyphae (blue arrows) are mainly present in the cytoplasm of the multinucleated giant cells (red arrows). (For interpretation of the references to color in this figure legend, the reader is referred to the web version of this article).