Cerebral and pulmonary phaeohyphomycosis due Cladophialophora bantiana in an immunocompromised patient

We report a case of disseminated Cladophialophora bantiana phaeohyphomycosis with cerebral and pulmonary disease in a 69-year-old renal transplant recipient. The patient presented with confusion, low-grade fever and progressed quickly to a comatose state. Imaging revealed multiple small brain abscesses and a right pulmonary nodule. Cultures of bronchial washings and biopsy of the right pulmonary nodule grew C. bantiana, a highly neurotropic fungus with a high mortality rate. He was treated with Isavuconazonium sulfate (Isavuconazole) and Liposomal Amphotericin B along with reduction immunosuppressive therapy. His neurologic status remained unimproved despite treatment with dual antifungal therapy for two months. The patient eventually died from respiratory failure 79 days after his initial presentation, C. bantiana has been reported in both immunocompetent and immunocompromised patients. Its neurotropism has been reported and described in the literature with C. bantiana responsible for 50 % of the reported cases of fungal brain abscess. However, reports of pulmonary and cerebral involvement are exceedingly rare. Our patient was immunocompromised and succumbed to cerebral involvement.