An Unusual Case of a Dematiaceous Fungus with an Exclusive Cerebral Involvement After ABO-Incompatible Renal Transplantation

Patient: Male, 46-year-old Final Diagnosis: Dermatological fungus involving brain in an ABO-incompatible renal transplantation Symptoms: Seizures Medication: — Clinical Procedure: — Specialty: Nephrology OBJECTIVE: Rare disease BACKGROUND: Cladophialophora carrionii was detected postoperatively in a cerebral space-occupying lesion of a patient who had undergone ABO-incompatible renal transplantation. The infection was successfully treated with oral terbinafine and itraconazole. CASE REPORT: An otherwise healthy 46-year-old man underwent ABO-incompatible renal transplantation. Postoperatively, he was hemodynamically stable and the graft was functioning well. Within 2 weeks, the patient developed clinical depression, followed by seizures and left-side hemiparesis. There were no skin findings. Radiological investigation showed 2 space-occupying lesions in the brain parenchyma. The patient’s condition improved after partial frontal lobectomy and microsurgical abscess evacuation, with a short course of liposomal amphotericin B and a combination of oral terbinafine and itraconazole. Microbiological examination of the pus showed growth of C. carrionii, which predominantly causes subcutaneous mycoses. CONCLUSIONS: It is very rare for melanized fungal infections to cause an exclusively cerebral disease without any skin involvement. Furthermore, among established cases, C. carrionii is a very rarely detected pathogen.