Fluorescence of Cladophialophora Bantiana After Administration of 5-Aminolevulinic Acid Hydrochloride: Case Report.

BACKGROUND AND IMPORTANCE: Cerebral phaeohyphomycosis caused by Cladophialophora bantiana carries a high mortality rate of approximately 70%. Prompt, complete resection is associated with improved patient outcomes, with surgeons typically relying on imaging for appropriate margins of resection. 5-aminolevulinic acid (5-ALA) has traditionally been used in patients with gliomas; however, when used in our case of a patient with C. bantiana mimicking glioma, 5-ALA illuminated the capsule, allowing for optimal excision.

CLINICAL PRESENTATION: An 81-year-old immunocompetent woman presented with dizziness, gait imbalance, headache, and left homonymous hemianopsia and was found to have right occipital hyperintensity concerning for malignancy. Subsequent craniotomy with 5-ALA fluorescence was performed, and the capsule was fully resected. On histopathological analysis, the sample revealed C. bantiana. Infectious disease was consulted, and the patient was treated with appropriate antifungals. Postoperatively, the fungus has completely resolved with no reported complications.

CONCLUSION: C. bantiana is a fungal infection with high mortality and poor prognosis, capable of invading immunocompetent hosts. In our case, the intraoperative use of 5-ALA allowed for optimal surgical excision and no postoperative complications to date. This study suggests that 5-ALA could be used in situations not restricted to glioma to promote decreased mortality and improved patient outcomes.