Primary cerebral pheohyphomycosis in an immunocompetent adult: A case report and review of the literature

Abstract

Cerebral pheohyphomycosis is a rare, life-threatening central nervous system infection caused by dematiaceous fungi. It predominantly affects immunocompromised individuals; however, cases in immunocompetent hosts have been increasingly reported, particularly in association with environmental exposure. The diagnosis is challenging due to nonspecific clinical manifestations and radiological features that often mimic neoplastic or bacterial lesions. We report the case of a previously healthy 45-year-old Kenyan male who presented with chronic headache and progressive neurological deficits. Neuroimaging revealed multiple intracranial lesions with significant mass effect. Stereotactic biopsy and microbiological analysis identified Cladophialophora species as the causative organism. The patient was managed with surgical drainage and prolonged antifungal therapy using liposomal amphotericin B and voriconazole, resulting in significant clinical improvement. This case highlights the importance of considering fungal infections in patients with atypical brain lesions, even in the absence of overt immunosuppression. Early recognition combined medical–surgical management, and prolonged antifungal therapy are critical for improving outcomes.