title: Acute meningitis caused by Cladosporium sphaerospermum.
abstract: Phaeohyphomycosis of the central nervous system is rare but typically associated with high mortality. Treatment has not been standardized, but the combination of antifungal chemotherapy with surgical debridement is recommended. We report a 73-year-old, retired, male timber merchant with acute meningitis caused by Cladosporium sphaerospermum. The patient, who had well-controlled type 2 diabetes mellitus, presented with fever and weakness of the lower limbs. No brain abscess was apparent by cranial computed tomography. C. sphaerospermum was isolated from the cerebral spinal fluid and identified based on both morphology and DNA sequencing. He was treated with combination antifungal chemotherapy with amphotericin B and voriconazole for 28 days, followed by voriconazole monotherapy for 46 days. To date, the patient has recovered without significant sequelae. This patient represents the first reported case of cerebral phaeohyphomycosis caused by C. sphaerospermum. Moreover, the therapy was successful for totally less than 3 months of treatment duration.
authors.affiliation: Division of Infectious Diseases (C-YC, P-LL, C-CL, KC, W-RL, C-YL, Y-HC), Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Internal Medicine (C-YC, KC), Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung, Taiwan; Division of Clinical Microbiology (P-LL, K-ML), Department of Laboratory Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; School of Medicine (P-LL, Y-HC), College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Medical Laboratory Science and Biotechnology (CC), College of Medicine, National Cheng Kung University, Tainan, Taiwan; and Graduate Institute of Medicine (C-YL, Y-HC), College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
authors.forename: Chi-Yu
authors.initials: CY
authors.lastname: Chen
authors.forename: Po-Liang
authors.initials: PL
authors.lastname: Lu
authors.forename: Kun-Mu
authors.initials: KM
authors.lastname: Lee
authors.forename: Tsung Chain
authors.initials: TC
authors.lastname: Chang
authors.forename: Chung-Chih
authors.initials: CC
authors.lastname: Lai
authors.forename: Ko
authors.initials: K
authors.lastname: Chang
authors.forename: Wei-Ru
authors.initials: WR
authors.lastname: Lin
authors.forename: Chun-Yu
authors.initials: CY
authors.lastname: Lin
authors.forename: Yen-Hsu
authors.initials: YH
authors.lastname: Chen
mesh_terms: D000368:Aged; D000666:Amphotericin B / Q000627:therapeutic use*; D000935:Antifungal Agents / Q000627:therapeutic use*; D002555:Cerebrospinal Fluid / Q000382:microbiology; D002963:Cladosporium / Q000302:isolation & purification*; D004359:Drug Therapy, Combination; D006801:Humans; D008297:Male; D016921:Meningitis, Fungal / Q000175:diagnosis* / Q000188:drug therapy* / Q000382:microbiology; D011743:Pyrimidines / Q000627:therapeutic use*; D013624:Taiwan; D016896:Treatment Outcome; D014230:Triazoles / Q000627:therapeutic use*; D065819:Voriconazole
chemical_list: D000935:Antifungal Agents; D011743:Pyrimidines; D014230:Triazoles; D000666:Amphotericin B; D065819:Voriconazole