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Brain abscess caused by Cladophialophora (Xylohypha) bantiana in a renal transplant patient
Author(s) -
Silveira E.R.,
Resende M.A.,
Mariano V.S.,
Coura W.A.,
Alkmim L.D.,
Vianna L.B.,
Starling C.E.,
Cruz G.G.,
Benício L.H.A.,
Paula A.M.,
Gomes J.A.,
Santos G.D.,
Macedo M.A.M.,
Salum R.E.,
Gontijo M.,
Rabello A.L.,
Caligiorne R.B.
Publication year - 2003
Publication title -
transplant infectious disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.69
H-Index - 67
eISSN - 1399-3062
pISSN - 1398-2273
DOI - 10.1034/j.1399-3062.2003.00020.x
Subject(s) - medicine , brain abscess , abscess , amphotericin b , fluconazole , surgery , septic shock , allotransplantation , immunosuppression , transplantation , sepsis , antifungal , dermatology
Infectious disease is the most significant cause of morbidity and mortality in allotransplantation because of heavy immunosuppression. Brain abscesses caused by melanized fungi have been found occasionally and are an example of this complication. In this paper, we describe a case in a 61‐year‐old black man, who received a cadaveric kidney transplantation in December 1993, followed by triple therapy with cyclosporine, azathioprine, and prednisone. The patient developed right hemiparesis at the beginning of April 1998. A computed tomography scan showed a mass in the left parieto‐temporal region of the brain. The patient underwent surgery and a brown‐colored encapsulated brain abscess was resected. Histology of the tissue revealed a large number of pigmented fungal hyphae. Culture in a Sabouraud dextrose medium with cyclohexamide and chloramphenicol at 25°C resulted in the growth of dark‐green colonies. The fungus identified was Cladophialophora bantiana , based on characteristic microscopic features and on growth at 40°C. The abscess recurred in spite of treatment with fluconazole. The patient was submitted to a second brain surgical procedure and was treated with amphotericin B in addition to fluconazole. Ten days later the patient's blood cultures became positive for Escherichia coli. After 3 days the patient died due to septic shock.