{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T00:29:39Z","timestamp":1786494579610,"version":"build-2736575974"},"reference-count":28,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"6","license":[{"start":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T00:00:00Z","timestamp":1786320000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Neurosurg Case Lessons"],"published-print":{"date-parts":[[2026,8,10]]},"abstract":"\n BACKGROUND<\/jats:title>\n Cerebral phaeohyphomycosis is a rare but often fatal CNS infection caused by dematiaceous fungi. Although most invasive fungal infections affect immunocompromised patients, this entity disproportionately affects immunocompetent individuals. No standardized treatment exists, and mortality frequently exceeds 70%, even with aggressive therapy.<\/jats:p>\n <\/jats:sec>\n \n OBSERVATIONS<\/jats:title>\n \n A previously healthy 64-year-old woman presented with progressive left-sided weakness and a parietal lesion with a presumed radiological diagnosis of high-grade glioma. She underwent three craniotomies due to rapid recurrence, and histopathological analysis and fungal culture ultimately revealed co-infection by\n Cladophialophora bantiana<\/jats:italic>\n and\n Curvularia hawaiiensis<\/jats:italic>\n \u2014a combination not previously reported in an immunocompetent host. Treatment included complete abscess excision, intrathecal and systemic liposomal amphotericin B, voriconazole, and flucytosine. At the 18-month follow-up, the patient remained clinically stable on suppressive therapy with no radiological recurrence.\n <\/jats:p>\n <\/jats:sec>\n \n LESSONS<\/jats:title>\n This case underscores the importance of considering fungal infections in rapidly recurring cerebral lesions, particularly when postoperative evolution deviates from expected patterns. Early recognition, prompt histological and microbiological diagnosis, repeated radical surgical debridement, and prolonged multimodal antifungal therapy were crucial to this patient\u2019s survival.<\/jats:p>\n \n https:\/\/thejns.org\/doi\/10.3171\/CASE26529<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/case26529","type":"journal-article","created":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T00:01:19Z","timestamp":1786492879000},"source":"Crossref","is-referenced-by-count":0,"title":["A glioblastoma mimic: successful multimodal treatment of a rare dual fungal brain abscess in an immunocompetent patient. Illustrative case"],"prefix":"10.3171","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-6105-0534","authenticated-orcid":true,"given":"Sara","family":"Nunes-Sequeira","sequence":"first","affiliation":[{"name":"Neurosurgery Department, Hospital Egas Moniz\u2013Lisbon Western Local Health Unit, Lisbon"},{"name":"Faculdade de Medicina da Universidade de Lisboa, Lisbon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ant\u00f3nio","family":"Barata","sequence":"additional","affiliation":[{"name":"Neuroradiology Department, Hospital Egas Moniz\u2013Lisbon Western Local Health Unit, Lisbon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mariana","family":"Paulos","sequence":"additional","affiliation":[{"name":"Neurosurgery Department, Hospital Egas Moniz\u2013Lisbon Western Local Health Unit, Lisbon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandra","family":"Matias","sequence":"additional","affiliation":[{"name":"Neuroradiology Department, Hospital Egas Moniz\u2013Lisbon Western Local Health Unit, Lisbon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6880-2726","authenticated-orcid":true,"given":"Pedro","family":"Soares","sequence":"additional","affiliation":[{"name":"Neuroradiology Department, Hospital Egas Moniz\u2013Lisbon Western Local Health Unit, Lisbon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martinha","family":"Chor\u00e3o","sequence":"additional","affiliation":[{"name":"Pathological Anatomy Department, Hospital Egas Moniz\u2013Lisbon Western Local Health Unit, Lisbon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4674-6065","authenticated-orcid":true,"given":"Cristina","family":"Toscano","sequence":"additional","affiliation":[{"name":"Microbiology Laboratory, Hospital Egas Moniz\u2013Lisbon Western Local Health Unit, Lisbon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4867-0364","authenticated-orcid":true,"given":"Susana","family":"Matos","sequence":"additional","affiliation":[{"name":"Microbiology Laboratory, Hospital Egas Moniz\u2013Lisbon Western Local Health Unit, Lisbon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"Casanova","sequence":"additional","affiliation":[{"name":"Infectious Diseases Department, Hospital Egas Moniz\u2013Lisbon Western Local Health Unit, Lisbon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-0082-5604","authenticated-orcid":true,"given":"Pedro","family":"Leal","sequence":"additional","affiliation":[{"name":"Infectious Diseases Department, Hospital Egas Moniz\u2013Lisbon Western Local Health Unit, Lisbon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carla","family":"Reizinho","sequence":"additional","affiliation":[{"name":"Neurosurgery Department, Hospital Egas Moniz\u2013Lisbon Western Local Health Unit, Lisbon"},{"name":"Neurosurgery Department, Hospital da Luz, Lisbon, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"2","key":"bib1","series-title":"Curr Med Mycol","first-page":"52","article-title":"Cerebral phaeohyphomycosis due to Cladophialophora bantiana in an immunocompetent individual: a case report and brief review of literature","volume":"6","author":"Rathod","year":"2020","unstructured":"Rathod PGMishra BThakur ACerebral phaeohyphomycosis due to Cladophialophora bantiana in an immunocompetent individual: a case report and brief review of literature. Curr Med Mycol. 2020;6(2):52-57. doi:10.18502\/CMM.6.2.2693"},{"issue":"2","key":"bib2","series-title":"Clin Infect Dis","first-page":"206","article-title":"Primary central nervous system phaeohyphomycosis: a review of 101 cases","volume":"38","author":"Revankar","year":"2004","unstructured":"Revankar SGSutton DARinaldi MG.Primary central nervous system phaeohyphomycosis: a review of 101 cases. Clin Infect Dis. 2004;38(2):206-216. doi:10.1086\/380635"},{"key":"bib3","series-title":"Clin Neurol Neurosurg","first-page":"107173","article-title":"Cerebral phaeohyphomycosis: the \u2018Dark Side\u2019 of fungal infections","volume":"214","author":"Latawa","year":"2022","unstructured":"Latawa APanda IKaur HCerebral phaeohyphomycosis: the \u2018Dark Side\u2019 of fungal infections. Clin Neurol Neurosurg. 2022;214:107173. doi:10.1016\/j.clineuro.2022.107173"},{"issue":"4","key":"bib4","series-title":"Germs","first-page":"597","article-title":"Fatal cerebral phaeohyphomycosis caused by Cladophialophora bantiana mimicking tuberculous brain abscess","volume":"11","author":"Samaddar","year":"2021","unstructured":"Samaddar APriyadarshi KShankarnarayan SAFatal cerebral phaeohyphomycosis caused by Cladophialophora bantiana mimicking tuberculous brain abscess. Germs. 2021;11(4):597-603. doi:10.18683\/germs.2021.1295"},{"issue":"10","key":"bib5","series-title":"BMJ Case Rep","first-page":"e246108","article-title":"Cladophialophora bantiana brain abscess with lymphadenitis","volume":"14","author":"Suri","year":"2021","unstructured":"Suri VPandey SGoyal NRani H.Cladophialophora bantiana brain abscess with lymphadenitis. BMJ Case Rep. 2021;14(10):e246108. doi:10.1136\/bcr-2021-246108"},{"issue":"3","key":"bib6","series-title":"J Fungi (Basel)","first-page":"60","article-title":"CNS infections caused by brown-black fungi","volume":"5","author":"Velasco","year":"2019","unstructured":"Velasco JRevankar S.CNS infections caused by brown-black fungi. J Fungi (Basel). 2019;5(3):60. doi:10.3390\/jof5030060"},{"issue":"1","key":"bib7","series-title":"BMC Infect Dis","first-page":"13","article-title":"Gram stain to the rescue: a case report of cerebral phaeohyphomycosis by Cladophialophora bantiana in an immunocompetent 24-year-old","volume":"22","author":"Mody","year":"2022","unstructured":"Mody PWada PBloch KCGram stain to the rescue: a case report of cerebral phaeohyphomycosis by Cladophialophora bantiana in an immunocompetent 24-year-old. BMC Infect Dis. 2022;22(1):13. doi:10.1186\/s12879-021-07008-4"},{"issue":"1","key":"bib8","series-title":"J Assoc Physicians India","first-page":"73","article-title":"Cladophialophora bantiana brain abscess in an immunocompetent host: a diagnostic challenge","volume":"73","author":"Kumar","year":"2025","unstructured":"Kumar RKhosla PTaneja VDessai RJain SSondhi M.Cladophialophora bantiana brain abscess in an immunocompetent host: a diagnostic challenge. J Assoc Physicians India. 2025;73(1):73-76. doi:10.59556\/japi.73.0812"},{"key":"bib9","series-title":"Med Mycol Case Rep","first-page":"43","article-title":"Brain abscess caused by Cladophialophora bantiana: total remission after full resection and short-course voriconazole treatment","volume":"23","author":"Schweizer","year":"2019","unstructured":"Schweizer LAB\u00e4rlocher LGraber ABoggian K.Brain abscess caused by Cladophialophora bantiana: total remission after full resection and short-course voriconazole treatment. Med Mycol Case Rep. 2019;23:43-45. doi:10.1016\/j.mmcr.2018.12.001"},{"issue":"4","key":"bib10","series-title":"Int J Infect Dis","first-page":"282","article-title":"Phaeohyphomycosis of the central nervous system in immunocompetent hosts: report of a case and review of the literature","volume":"7","author":"Filizzola","year":"2003","unstructured":"Filizzola MJMartinez FRauf SJ.Phaeohyphomycosis of the central nervous system in immunocompetent hosts: report of a case and review of the literature. Int J Infect Dis. 2003;7(4):282-286. doi:10.1016\/s1201-9712(03)90108-1"},{"issue":"6","key":"bib11","series-title":"Med Mycol","first-page":"579","article-title":"An updated comprehensive systematic review of Cladophialophora bantiana and analysis of epidemiology, clinical characteristics, and outcome of cerebral cases","volume":"55","author":"Kantarcioglu","year":"2017","unstructured":"Kantarcioglu ASGuarro JDe Hoog SApaydin HKiraz N.An updated comprehensive systematic review of Cladophialophora bantiana and analysis of epidemiology, clinical characteristics, and outcome of cerebral cases. Med Mycol. 2017;55(6):579-604. doi:10.1093\/mmy\/myw124"},{"issue":"8","key":"bib12","series-title":"Lancet Infect Dis","first-page":"e246","article-title":"Global guideline for the diagnosis and management of rare mould infections: an initiative of the European Confederation of Medical Mycology in cooperation with the International Society for Human and Animal Mycology and the American Society for Microbiology","volume":"21","author":"Hoenigl","year":"2021","unstructured":"Hoenigl MSalmanton-Garc\u00eda JWalsh TJGlobal guideline for the diagnosis and management of rare mould infections: an initiative of the European Confederation of Medical Mycology in cooperation with the International Society for Human and Animal Mycology and the American Society for Microbiology. Lancet Infect Dis. 2021;21(8):e246-e257. doi:10.1016\/S1473-3099(20)30784-2"},{"issue":"4","key":"bib13","series-title":"Ann Clin Lab Sci","first-page":"439","article-title":"Disseminated phaeohyphomycosis with brain abscess and biliary invasion due to Bipolaris spp. in an immunocompetent patient","volume":"46","author":"Frank","year":"2016","unstructured":"Frank TEsquenazi YNigo MWanger APortnoy BShepard S.Disseminated phaeohyphomycosis with brain abscess and biliary invasion due to Bipolaris spp. in an immunocompetent patient. Ann Clin Lab Sci. 2016;46(4):439-442."},{"issue":"2","key":"bib14","series-title":"Med Mycol","first-page":"111","article-title":"Brain abscess due to Cladophialophora bantiana: a review of 124 cases","volume":"54","author":"Chakrabarti","year":"2016","unstructured":"Chakrabarti AKaur HRudramurthy SMBrain abscess due to Cladophialophora bantiana: a review of 124 cases. Med Mycol. 2016;54(2):111-119. doi:10.1093\/mmy\/myv091"},{"issue":"4","key":"bib15","series-title":"Can J Infect Dis Med Microbiol","first-page":"149","article-title":"Cladophialophora bantiana brain abscess in an immunocompetent patient","volume":"22","author":"Revankar","year":"2011","unstructured":"Revankar SGRevankar G.Cladophialophora bantiana brain abscess in an immunocompetent patient. Can J Infect Dis Med Microbiol. 2011;22(4):149-150. doi:10.1155\/2011\/642517"},{"issue":"4","key":"bib16","series-title":"J Mycol Med","first-page":"101156","article-title":"Clinicomycological overview of brain abscess in a tertiary care center: a 38 year retrospection: fungal brain abscess","volume":"31","author":"P","year":"2021","unstructured":"P KRaj PJabeen SClinicomycological overview of brain abscess in a tertiary care center: a 38 year retrospection: fungal brain abscess. J Mycol Med. 2021;31(4):101156. doi:10.1016\/j.mycmed.2021.101156"},{"issue":"3","key":"bib17","series-title":"Surg Neurol","first-page":"254","article-title":"Intracranial fungal granuloma: analysis of 40 patients and review of the literature","volume":"63","author":"Dubey","year":"2005","unstructured":"Dubey APatwardhan RVSampth SSantosh VKolluri SNanda A.Intracranial fungal granuloma: analysis of 40 patients and review of the literature. Surg Neurol. 2005;63(3):254-260. doi:10.1016\/j.surneu.2004.04.020"},{"issue":"6","key":"bib18","series-title":"Lancet Infect Dis","first-page":"376","article-title":"Cerebral phaeohyphomycosis\u2014a cure at what lengths?","volume":"9","author":"Li","year":"2009","unstructured":"Li DMde Hoog GS.Cerebral phaeohyphomycosis\u2014a cure at what lengths? Lancet Infect Dis. 2009;9(6):376-383. doi:10.1016\/S1473-3099(09)70131-8"},{"issue":"5","key":"bib19","series-title":"Med Mycol","first-page":"481","article-title":"Cladophialophora bantiana: a rare cause of fungal brain abscess. Clinical aspects and new therapeutic options","volume":"46","author":"Garzoni","year":"2008","unstructured":"Garzoni CMarkham LBijlenga PGarbino J.Cladophialophora bantiana: a rare cause of fungal brain abscess. Clinical aspects and new therapeutic options. Med Mycol. 2008;46(5):481-486. doi:10.1080\/13693780801914906"},{"key":"bib20","series-title":"Clin Neurol Neurosurg","first-page":"179","article-title":"Cerebral phaeohyphomycosis in an immunocompetent patient: a case report and literature summary","volume":"124","author":"Litchevski","year":"2014","unstructured":"Litchevski VGoldschmidt ANass DRahav GCohen ZR.Cerebral phaeohyphomycosis in an immunocompetent patient: a case report and literature summary. Clin Neurol Neurosurg. 2014;124:179-181. doi:10.1016\/j.clineuro.2014.07.003"},{"issue":"3","key":"bib21","series-title":"J Neuroophthalmol","first-page":"399","article-title":"Double vision and gait ataxia in an immunocompetent 9-year-old girl with intracranial phaeohyphomycosis","volume":"41","author":"Pareek","year":"2021","unstructured":"Pareek AVLotze TEDemmler GMohila CATran BShah VS.Double vision and gait ataxia in an immunocompetent 9-year-old girl with intracranial phaeohyphomycosis. J Neuroophthalmol. 2021;41(3):399-403. doi:10.1097\/WNO.0000000000001204"},{"issue":"suppl 3","key":"bib22","series-title":"Clin Microbiol Infect","first-page":"47","article-title":"ESCMID and ECMM joint clinical guidelines for the diagnosis and management of systemic phaeohyphomycosis: diseases caused by black fungi","volume":"20","author":"Chowdhary","year":"2014","unstructured":"Chowdhary AMeis JFGuarro JESCMID and ECMM joint clinical guidelines for the diagnosis and management of systemic phaeohyphomycosis: diseases caused by black fungi. Clin Microbiol Infect. 2014;20(suppl 3):47-75. doi:10.1111\/1469-0691.12515"},{"issue":"4","key":"bib23","series-title":"Antimicrob Agents Chemother","first-page":"2346","article-title":"Combination of amphotericin B and flucytosine against neurotropic species of melanized fungi causing primary cerebral phaeohyphomycosis","volume":"60","author":"Deng","year":"2016","unstructured":"Deng SPan WLiao WCombination of amphotericin B and flucytosine against neurotropic species of melanized fungi causing primary cerebral phaeohyphomycosis. Antimicrob Agents Chemother. 2016;60(4):2346-2351. doi:10.1128\/AAC.02526-15"},{"issue":"4","key":"bib24","series-title":"Lancet Neurol","first-page":"362","article-title":"Advances in the diagnosis and treatment of fungal infections of the CNS","volume":"17","author":"Schwartz","year":"2018","unstructured":"Schwartz SKontoyiannis DPHarrison TRuhnke M.Advances in the diagnosis and treatment of fungal infections of the CNS. Lancet Neurol. 2018;17(4):362-372. doi:10.1016\/S1474-4422(18)30030-9"},{"issue":"1","key":"bib25","series-title":"Clin Microbiol Infect","first-page":"66","article-title":"European Society of Clinical Microbiology and Infectious Diseases guidelines on diagnosis and treatment of brain abscess in children and adults","volume":"30","author":"Bodilsen","year":"2024","unstructured":"Bodilsen JD\u2019Alessandris QGHumphreys HEuropean Society of Clinical Microbiology and Infectious Diseases guidelines on diagnosis and treatment of brain abscess in children and adults. Clin Microbiol Infect. 2024;30(1):66-89. doi:10.1016\/j.cmi.2023.08.016"},{"key":"bib26","series-title":"J Neurol Sci","first-page":"117325","article-title":"CNS fungal infections: a review","volume":"422","author":"Nathan","year":"2021","unstructured":"Nathan CLEmmert BENelson EBerger JR.CNS fungal infections: a review. J Neurol Sci. 2021;422:117325. doi:10.1016\/j.jns.2021.117325"},{"issue":"1","key":"bib27","series-title":"J Mycol Med","first-page":"100918","article-title":"Cerebral phaeohyphomycosis due to Cladophialophora bantiana in a French Guianese child","volume":"30","author":"Miossec","year":"2020","unstructured":"Miossec CJacob SPeipoch LCerebral phaeohyphomycosis due to Cladophialophora bantiana in a French Guianese child. J Mycol Med. 2020;30(1):100918. doi:10.1016\/j.mycmed.2019.100918"},{"issue":"5","key":"bib28","series-title":"Neurosurg Rev","first-page":"3139","article-title":"5-aminolevulinic acid fluorescence in brain non-neoplastic lesions: a systematic review and case series","volume":"45","author":"Duarte","year":"2022","unstructured":"Duarte JFSJung GSda Silva EBde Almeida Teixeira BCCavalcanti MSRamina R.5-aminolevulinic acid fluorescence in brain non-neoplastic lesions: a systematic review and case series. 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