Brain Abscess in an Immunocompetent Host: A Diagnostic Challenge.

Cladophialophora bantiana has been identified as one of the most common causes of cerebral pheohyphomycosis. While intrafungal cerebral abscesses are historically known to be associated with immunocompromised patients, C. bantiana has a specific predilection for immunocompetent hosts. Successful treatment is based on accurate microbiological and histopathological diagnosis as well as the initiation of targeted antifungal treatment. We hereby report a case of a 64-year-old male who presented with atypical chest pain for 1 day, pain in both lower limbs, and blackish discoloration of the left foot. He also had left foot drop for 1 month. During his hospital stay, he developed a lower respiratory tract infection, was diagnosed with polycythemia vera, and later developed severe headache and dizziness. He was found to have a space-occupying lesion in the cerebellum and a pulmonary nodule. He was started on antitubercular therapy based on a lung biopsy suggestive of necrotizing granulomatous inflammation. However, the patient's sensorium kept worsening, and he was intubated. The fever persisted, and he had episodes of upper and lower gastrointestinal (GI) bleed. His sensorium continued to worsen. Autoimmune and immunodeficiency workups were inconclusive. Repeat imaging suggested an increase in the size of the lesions. Suboccipital craniectomy was performed and showed the growth of C. bantiana.