SHM Converge Scientific Abstract ePoster Gallery-Black Mold in the Brain: A Case of Cladophialophora Bantiana Cerebral Abscess in a Patient With Eosinophilic Pneumonia on Mepolizumab Therapy

Black Mold in the Brain: A Case of Cladophialophora Bantiana Cerebral Abscess in a Patient With Eosinophilic Pneumonia on Mepolizumab Therapy

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This case report describes a 64-year-old woman with eosinophilic pneumonia, eosinophilic myocarditis, and hypothyroidism who presented with four days of progressive left-sided weakness and fecal incontinence. Brain imaging showed a right parietal mass with rim enhancement, initially concerning for tumor but later found to be a cerebral abscess. After craniotomy and abscess evacuation, cultures identified <strong>Cladophialophora bantiana</strong>, a rare dematiaceous “black mold” known to cause highly lethal brain infections.

The patient had previously used corticosteroids but was currently receiving <strong>mepolizumab</strong>, an IL-5 antagonist used to control eosinophilic disease and reduce steroid dependence. Her case raises concern about whether newer biologic immunosuppressive therapies may increase susceptibility to opportunistic fungal infections, although no direct causal link between mepolizumab and cerebral phaeohyphomycosis has been established.

She was treated initially with <strong>amphotericin and voriconazole</strong>, then continued on <strong>voriconazole monotherapy</strong>. She was discharged with prolonged Infectious Disease follow-up and planned antifungal treatment for 6–12 months until radiographic resolution. Because of the risk of life-threatening hypereosinophilia with cardiac involvement, Allergy continued mepolizumab outpatient despite the infection.

The report emphasizes that <strong>C. bantiana</strong> brain abscesses are rare, often present with nonspecific neurologic symptoms, and carry mortality rates reported as high as 70% even with surgery and antifungals. Effective management typically requires prompt diagnosis, aggressive surgical drainage, prolonged antifungal therapy, and careful balancing of immunosuppression. Ongoing imaging and long-term follow-up are essential because relapse can occur late.

Asset Subtitle

Audrey Shawley

Meta Tag

Author List Audrey Shawley, Krystal Hirayama, Laya Reddy

Category Clinical Vignettes

Concept Cladophialophora bantiana

Concept Cerebral Abscess

Concept Surgical Evacuation

Concept Antifungal Therapy

Concept Neurologic Deficit

Distinguished Non-Finalist

Presenter Organization Scripps Mercy Hospital San Diego

Presenting Author Audrey Shawley

Track Adult

Keywords

Cladophialophora bantiana

brain abscess

cerebral phaeohyphomycosis

eosinophilic pneumonia

eosinophilic myocarditis

mepolizumab

opportunistic fungal infection

voriconazole

amphotericin

immunosuppression

Cladophialophora bantiana

Cerebral Abscess

Surgical Evacuation

Antifungal Therapy

Neurologic Deficit