Cerebral phaeohyphomycosis.

Multiple phaeohyphomycotic brain abscesses caused by Cladosporium species occurred in a 55 year old woman. No immunological abnormality could be detected. The disease ran a protracted course for a total of 20 months before she died from sudden rupture of an abscess loculus into the ventricular system. Course was characterised by spontaneous remissions and relapses totally independent of adequate doses and prolonged regimes of all the three available anti-fungal chemotherapeutic agents, namely amphotericin B, flucytosine and ketoconazole. Three surgical procedures were carried out; and surgical intervention appeared to be the only modality of treatment capable of prolonging the life or altering the course of the disease. An interesting transitory pulmonary phase of phaeohyphomycosis resembling miliary tuberculosis was noticed. This may help to explain the portal of entry and mole of spread of the fungus to the brain. A dematiaceous fungus was isolated from these abscesses. Mycologic features and histology of brain lesions are described.