title: Multiple brain abscesses caused by Rhinocladiella mackenziei in an immunocompetent patient: a case report and literature review.
abstract: Primary cerebral phaeohyphomycosis due to Rhinocladiella mackenziei is an extremely rare infection carrying more than 80% mortality, with most cases reported from the Middle East region. This darkly pigmented black yeast is highly neurotropic, aggressive and refractory to most antifungal agents. Here we present an immunocompetent elderly male, presenting with multiple brain abscesses, with R. mackenziei confirmed by nuclear ribosomal repeat region sequencing, who was successfully treated by surgical debridement and intravenous voriconazole. To our knowledge this is the first case reported from the United Kingdom. We also present a review of all such cases so far reported in the English literature world-wide, which we believe is a step further to understanding the pathogenesis and establishing effective treatment of this rare, yet often fatal disease.
authors.affiliation: Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, Queen Square, London, WC1N 3BG, UK.
authors.forename: Natan
authors.initials: N
authors.lastname: Yusupov
authors.affiliation: Department of Neuropathology, National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, Queen Square, London, UK.
authors.forename: Ashirwad
authors.initials: A
authors.lastname: Merve
authors.affiliation: Department of Microbiology, National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, 60 Whitfield St, London, W1T 4EU, UK.
authors.forename: Clare E
authors.initials: CE
authors.lastname: Warrell
authors.affiliation: Mycology Reference Laboratory, Public Health England , Bristol, UK.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Johnson
authors.affiliation: Department of Microbiology, National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, 60 Whitfield St, London, W1T 4EU, UK.
authors.forename: Carmel
authors.initials: C
authors.lastname: Curtis
authors.affiliation: Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, Queen Square, London, WC1N 3BG, UK. George.Samandouras@uclh.nhs.uk.
authors.forename: George
authors.initials: G
authors.lastname: Samandouras
mesh_terms: D000368:Aged; D000935:Antifungal Agents / Q000627:therapeutic use; D001203:Ascomycota / Q000472:pathogenicity*; D001922:Brain Abscess / Q000188:drug therapy / Q000382:microbiology* / Q000601:surgery; D020314:Central Nervous System Fungal Infections / Q000188:drug therapy / Q000382:microbiology* / Q000601:surgery; D003646:Debridement / Q000379:methods; D006801:Humans; D008297:Male
chemical_list: D000935:Antifungal Agents
keywords: Abscess; Brain; Fungal; Rhinocladiella mackenziei