SHM Converge Scientific Abstract ePoster Gallery-Cladophialophora Brain Abscess Mimicking Primary Brain Tumor

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This case report describes a rare <strong>Cladophialophora bantiana</strong> brain abscess in a <strong>73-year-old immunocompetent man</strong> who presented with progressive <strong>right-sided weakness</strong> and <strong>word-finding difficulty</strong>. Initial neuroimaging suggested a <strong>left peri-Rolandic glioma</strong>, but MRI later showed a <strong>ring-enhancing lesion with restricted diffusion</strong>, raising suspicion for a brain abscess instead of a tumor. A <strong>stereotactic biopsy</strong> confirmed <strong>Cladophialophora fungal abscess</strong>, a dematiaceous, neurotropic fungus known to cause <strong>cerebral phaeohyphomycosis</strong> even in healthy individuals.

Chest CT revealed a <strong>transient pulmonary nodule with a halo sign</strong> and a <strong>ground-glass opacity</strong>, suggesting possible <strong>hematogenous fungal dissemination</strong> and a potential extracranial source of infection. The patient was treated with <strong>voriconazole</strong> and supportive care, with substantial neurological improvement before discharge to a skilled nursing facility.

The report highlights the major diagnostic challenge of <strong>fungal brain abscesses mimicking primary brain tumors</strong> on imaging. It emphasizes that <strong>tissue biopsy is essential</strong> for distinguishing infection from neoplasm, especially when MRI findings are ambiguous. The authors also stress the value of <strong>chest imaging</strong> in looking for possible infectious entry points or signs of dissemination. Prompt recognition, multidisciplinary evaluation, and targeted antifungal therapy were key to the patient’s recovery.

Asset Subtitle

David Kornblum

Meta Tag

Author List David Kornblum, Dennis Boyle, John Greene, Maria F. Rosero Basurto

Category Clinical Vignettes

Concept Cladophialophora bantiana

Concept Cerebral phaeohyphomycosis

Concept Pigmented septate hyphae

Concept Fungal brain abscess

Concept Stereotactic biopsy

Distinguished Non-Finalist

Presenter Organization Usf

Presenting Author David Kornblum

Track Adult

Keywords

Cladophialophora bantiana

brain abscess

immunocompetent man

ring-enhancing lesion

restricted diffusion

stereotactic biopsy

cerebral phaeohyphomycosis

voriconazole

fungal brain abscess

hematogenous dissemination

Cladophialophora bantiana

Cerebral phaeohyphomycosis

Pigmented septate hyphae

Fungal brain abscess

Stereotactic biopsy