Cerebral phaeohyphomycosis complicated with brain abscess: a case report.

Cerebral phaeohyphomycosis is used to describe the rare clinical syndrome of cerebral infection caused by dematiaceous (i.e. pigmented olivaceous-brown) fungi. It usually presents as brain abscess. In view of the rarity of this fungal infection and its clinical importance, we report a case of cerebral phaeohyphomycosis caused by Xylohypha bantiana. The patient presented with a seizure attack. The MRI study revealed a ring-enhancing lesion with marked perifocal edema in right high frontoparietal junction of the brain. He underwent an initial craniotomy for removal of the lesion and a second craniotomy for recurrence of the lesion 3 months later. The diagnosis was based on successful cultivation of X. bantiana from the surgical specimen and on histopathology. The patient received antifungal drug therapy of 5-flucytosine and itraconazole. He has done well without any symptoms. We think complete surgical removal of the brain abscess combined with antifungal drug therapy is the best management for this rare fungal disease.