Coexisting phaeohyphomycosis and tubercular central nervous system infections in an immunocompetent child: A case report
Abstract
BACKGROUND: Diagnosing chronic meningitis is a clinical challenge. Infection with cerebral phaeohyphomycosis, caused by dematiaceous (melanized) fungi, is extremely rare but is a life-threatening cerebral abscess. It presents with non-specific signs and symptoms and carries a poor prognosis, regardless of the patient’s immune status. In endemic regions, it closely mimics common conditions such as tuberculous meningitis or intracranial tuberculomas, complicating timely diagnosis and management.
CASE SUMMARY: We present the case of 10-year-old immunocompetent child who was admitted with fever, headache, and meningeal signs. Initial neuroimaging revealed multiple ring-enhancing, conglomerated lesions with perilesional oedema in left temporo-parietal region. Cerebrospinal fluid analysis showed pleocytosis with lymphocytic predominance and highly raised protein levels. Based on clinical-radiological findings and the regional prevalence of tuberculosis (TB), child was initially diagnosed and treated as a case of central nervous system TB with standard anti-tubercular therapy (ATT) & adjunctive steroids. After 5-6 weeks, the patient was readmitted with worsening raised intracranial pressure. Repeat neuroimaging revealed an increase in abscess size along with oedema. Craniotomy with evacuation of the abscess was performed. Direct microscopy of aspirated pus showed pigmented, septate fungal hyphae consistent with phaeohyphomycosis. Histopathological examination also demonstrated features of coexisting tubercular pathology. Child was treated with combined antifungal therapy (liposomal amphotericin B) for 6 weeks and ATT, resulting in clinical and radiological improvement.
CONCLUSION: Case highlights the diagnostic dilemma posed by cerebral phaeohyphomycosis, particularly in regions endemic for TB. It emphasizes the need to consider alternative or dual infections in paediatric patients with poor response to standard treatments. Early suspicion, prompt surgical intervention, and targeted medical therapy are critical for improving outcomes.
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BibTeX
@article{soni2026coexisting,
title = {{Coexisting phaeohyphomycosis and tubercular central nervous system infections in an immunocompetent child: A case report}},
author = {Anil Soni and Nikhil Yamala and Gayatri Krishnan and Harika Attilli and Hema Mittal},
journal = {World Journal of Clinical Pediatrics},
year = {2026},
month = nov,
doi = {10.5409/wjcp.120132},
url = {https://doi.org/10.5409/wjcp.120132},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Coexisting phaeohyphomycosis and tubercular central nervous system infections in an immunocompetent child: A case report
AU - Anil Soni
AU - Nikhil Yamala
AU - Gayatri Krishnan
AU - Harika Attilli
AU - Hema Mittal
PY - 2026
DA - 2026/11/03
JO - World Journal of Clinical Pediatrics
DO - 10.5409/wjcp.120132
UR - https://doi.org/10.5409/wjcp.120132
AB - BACKGROUND: Diagnosing chronic meningitis is a clinical challenge. Infection with cerebral phaeohyphomycosis, caused by dematiaceous (melanized) fungi, is extremely rare but is a life-threatening cerebral abscess. It presents with non-specific signs and symptoms and carries a poor prognosis, regardless of the patient’s immune status. In endemic regions, it closely mimics common conditions such as tuberculous meningitis or intracranial tuberculomas, complicating timely diagnosis and management. CASE SUMMARY: We present the case of 10-year-old immunocompetent child who was admitted with fever, headache, and meningeal signs. Initial neuroimaging revealed multiple ring-enhancing, conglomerated lesions with perilesional oedema in left temporo-parietal region. Cerebrospinal fluid analysis showed pleocytosis with lymphocytic predominance and highly raised protein levels. Based on clinical-radiological findings and the regional prevalence of tuberculosis (TB), child was initially diagnosed and treated as a case of central nervous system TB with standard anti-tubercular therapy (ATT) & adjunctive steroids. After 5-6 weeks, the patient was readmitted with worsening raised intracranial pressure. Repeat neuroimaging revealed an increase in abscess size along with oedema. Craniotomy with evacuation of the abscess was performed. Direct microscopy of aspirated pus showed pigmented, septate fungal hyphae consistent with phaeohyphomycosis. Histopathological examination also demonstrated features of coexisting tubercular pathology. Child was treated with combined antifungal therapy (liposomal amphotericin B) for 6 weeks and ATT, resulting in clinical and radiological improvement. CONCLUSION: Case highlights the diagnostic dilemma posed by cerebral phaeohyphomycosis, particularly in regions endemic for TB. It emphasizes the need to consider alternative or dual infections in paediatric patients with poor response to standard treatments. Early suspicion, prompt surgical intervention, and targeted medical therapy are critical for improving outcomes.
SN - 2219-2808
ER -