Phaeohyphomycosis as a rare cause of brain abscess in immunocompetent patients: Report of two cases.
4 affiliations
- 1Department of Neurosurgery, Paulo Niemeyer State Brain Institute, Petrópolis, Brazil.
- 2Department of Neurosurgery, Petrópolis School of Medicine, Petrópolis, Brazil.
- 3Department of Radiology, Paulo Niemeyer State Brain Institute, Rio de Janeiro, Brazil.
- 4Department of Pathology, Paulo Niemeyer State Brain Institute, Rio de Janeiro, Brazil.
Abstract
Background
Cerebral phaeohyphomycosis (CPHM) is an uncommon and life-threatening infection caused by a variety of dematiaceous fungi, especially rare in immunocompetent individuals. Due to its nonspecific clinical and radiological presentation, it is frequently misdiagnosed, delaying appropriate treatment and leading to poor outcomes. We aim to describe radiological and histopathological findings of patients with CPHM treated at our institution, highlighting the role of combined aggressive treatment on clinical outcomes.Case description
We present two cases of brain phaeohyphomycosis in healthy women, aged 58 and 73 years. The first presented with hemiparesis, headache, and seizure. The second presented similarly, in addition to a decrease in level of consciousness and vomiting. Radiologically, the lesions showed ring peripheral enhancement on T1-weighted imaging, hyperperfusion in the lesion capsule, and extensive surrounding edema. Both occurred in the frontal lobe. Histopathological examination confirmed CPHM, revealing chronic granulomatous inflammation with multinucleated giant cells containing pigmented fungal hyphae. Gross total resection was performed, followed by systemic antifungal therapy. Fungal cultures were negative. One patient died.Conclusion
These cases highlight the diagnostic challenge and therapeutic significance of early recognition and aggressive management of CPHM. Surgical resection combined with systemic antifungal therapy can improve prognosis.
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BibTeX
@article{scolin2026phaeohyphomycosis,
title = {{Phaeohyphomycosis as a rare cause of brain abscess in immunocompetent patients: Report of two cases.}},
author = {Eliza Maria Bertolaccini Scolin and Anna Beatriz de Aguiar Araujo and Emanuel Abrantes Barros and Luiza Nahoum and Fabíola Varela Dias Berle and Bruna Dias Rocha and Paulo Luiz Cruz and Leila Maria Cardão Chimelli and Gabriela de Almeida Lima Rego and Paulo José da Mata Pereira and Paulo Niemeyer Filho},
journal = {Surgical neurology international},
year = {2026},
month = oct,
doi = {10.25259/sni_730_2026},
url = {https://europepmc.org/article/MED/42974217},
note = {CC BY-NC-SA},
}
RIS
TY - JOUR
TI - Phaeohyphomycosis as a rare cause of brain abscess in immunocompetent patients: Report of two cases.
AU - Eliza Maria Bertolaccini Scolin
AU - Anna Beatriz de Aguiar Araujo
AU - Emanuel Abrantes Barros
AU - Luiza Nahoum
AU - Fabíola Varela Dias Berle
AU - Bruna Dias Rocha
AU - Paulo Luiz Cruz
AU - Leila Maria Cardão Chimelli
AU - Gabriela de Almeida Lima Rego
AU - Paulo José da Mata Pereira
AU - Paulo Niemeyer Filho
PY - 2026
DA - 2026/10/16
JO - Surgical neurology international
DO - 10.25259/sni_730_2026
UR - https://europepmc.org/article/MED/42974217
AB - Background Cerebral phaeohyphomycosis (CPHM) is an uncommon and life-threatening infection caused by a variety of dematiaceous fungi, especially rare in immunocompetent individuals. Due to its nonspecific clinical and radiological presentation, it is frequently misdiagnosed, delaying appropriate treatment and leading to poor outcomes. We aim to describe radiological and histopathological findings of patients with CPHM treated at our institution, highlighting the role of combined aggressive treatment on clinical outcomes.Case description We present two cases of brain phaeohyphomycosis in healthy women, aged 58 and 73 years. The first presented with hemiparesis, headache, and seizure. The second presented similarly, in addition to a decrease in level of consciousness and vomiting. Radiologically, the lesions showed ring peripheral enhancement on T1-weighted imaging, hyperperfusion in the lesion capsule, and extensive surrounding edema. Both occurred in the frontal lobe. Histopathological examination confirmed CPHM, revealing chronic granulomatous inflammation with multinucleated giant cells containing pigmented fungal hyphae. Gross total resection was performed, followed by systemic antifungal therapy. Fungal cultures were negative. One patient died.Conclusion These cases highlight the diagnostic challenge and therapeutic significance of early recognition and aggressive management of CPHM. Surgical resection combined with systemic antifungal therapy can improve prognosis.
SN - 2229-5097
SN - 2152-7806
ER -