Reactions 1704, p275 - 2 Jun 2018 Mycophenolate-mofetil/prednisolone/ tacrolimus Cladophialophora bantiana brain abscess: case report A 49-year-old woman developed a brain abscess caused by Cladophialophora bantiana (C.bantiana) while receiving immunosuppresive treatment with tacrolimus, mycophenolate mofetil and prednisolone [routes not stated]. The woman presented to a hospital on November 2013, with headache, weakness and occasional falls. She had a history of end stage renal disease due to cresenteric glomerulonephritis for which she had undergone renal transplantation 3 years earlier. She was on triple immunosuppressant therapy with tacrolimus 1mg twice daily, mycophenolate mofetil 250mg once daily and prednisolone 10mg once daily. Additionally, she reported experiencing similar symptoms four months prior to the presentation, and had undergone cranial burr-hole surgery for the same, in August 2013. Her physical examination showed normal pulse and BP. Neurological examination was unremarkable. However, she was experiencing difficulty in sustained attention and was found to have executive dysfunction and gait apraxia. A brain CT showed a 30×30mm hypodense mass with a smooth thin wall with peri-mass oedema in the left frontal cerebrum consistent with an abscess. Subsequently, she underwent a left frontal craniotomy, and the mass was removed totally. A pathological examination showed a greyish white, encapsulated and nodular mass. A transection of the mass showed a cystic cavity filled with pus. Microscopic examination of the capsular pus after digestion with KOH revealed numerous brown pigmented branching hyphae along with brown pigmented septate round bodies. A Grocot’s methanamine silver stain showed chained and elongated fungal elements. A histology of the abscess cavity showed a wall composed of fibrocollagenous tissue lined by granulation tissue with mixed acute and chronic inflammatory cells, histiocyte aggregates, foreign body type, Langhans’ giant cells and several acute angle septate fungal hyphae. The unstained KOH wet mount showed brown pigmented hyphae, based on which a provisional diagnosis of cerebral phaeohyphomycosis was made. The woman’s treatment was initiated with posaconazole. After about 6 days, the culture isolated fungal colonies with olive grey velvety appearance with a black under surface. A lactophenol cotton blue wet mount preparation of the culture showed oval conidia in long sparsely branched conidiophores. The organism was identified as C. bantiana on microscopy by morphology and the fact that the fungus grew at 25°C, 37°C and also at 42°C as well as urease positivity. Her symptoms improved after the surgical excision. Her headaches improved. Within five days of the surgery, she was able to walk on her own without the risk of falling. She was discharged on the seventh post-operative day on posaconazole. At 6 months follow-up, she was doing well without neurological deficits and the CT scan showed no residual cerebral lesions. Her posaconazole therapy was continued. Author comment: "CNS infection with C. bantiana is nearly always a cerebral abscess; it can cause infection in immunocompromised and non-immunocompromised patients". "In summary, we reported here the case of a cerebral abscess caused by Cladophialophora bantiana treated successfully with complete excision of the abscess followed by chronic oral treatment with posaconazole." Ray U, et al. A CLADOPHIALOPHORA BRAIN ABSCESS IN A RENAL TRANSPLANT RECIPIENT. SouthEast Asian Journal of Tropical Medicine and Public Health 47: 1026-31, No. 5, Sep 2016. Available from: URL: http:// www.tm.mahidol.ac.th/seameo/2016-47-5/18-664426-1026.pdf - India 803322897 0114-9954/18/1704-0001/$14.95 Adis © 2018 Springer International Publishing AG. All rights reserved Reactions 2 Jun 2018 No. 1704
Reactions Weekly – Springer Journals
Published: Jun 2, 2018
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