Cerebral phaeohyphomycosis—a cure at what lengths?

SummaryCerebral phaeohyphomycosis is a fungal infection of the brain typically caused by Cladophialophora bantiana, Exophiala dermatitidis, and Rhinocladiella mackenziei, all of which belong to the order Chaetothyriales. The disease results in black, necrotic brain tissue, black pus, and black cerebrospinal fluid. Pathogens usually reach the brain through the bloodstream or lymphatic fluid and occasionally through direct spreading or accidental inoculation. Patients can present with hemiparesis, tonic spasm, headache, fever, sensory variation, cerebral irritation, and even psychotic behavioural changes. Radiological images are characterised by ring-enhanced signs and hyperdense and hypodense lesions. Pathological features frequently include black-to-brown necrotic tissue or dark-coloured pus, granulomatous inflammation, giant cell vasculitis, and pigmented fungal elements, which are easily seen on a direct potassium hydroxide smear, a rapid method for diagnosis. Black fungi can be cultured from a biopsy specimen. Combined antifungal chemotherapy, surgical debridement, and careful immunological interventions are strongly recommended to eradicate these intractable infections.