Rhino-orbito-cerebral fungal infection associated with mixed Cladosporium halotolerans and Penicillium corylophilum, complicated by internal carotid artery occlusion and ischemic stroke: a case report.

Rhino-orbito-cerebral infection is a rare but potentially life-threatening condition that usually occurs in immunocompromised patients. Identification of the causative organism is often challenging. A 71-year-old man without overt immunosuppression, such as corticosteroid use or chemotherapy, presented with visual loss in the left eye and was found to have internal carotid artery occlusion complicated by ischemic stroke. Despite extensive investigations, including surgical biopsy, a definitive diagnosis could not be established for nearly 4 months. Fungal infection was eventually confirmed by culturing a large volume (10 mL) of cerebrospinal fluid (CSF), which revealed a mixed infection with Cladosporium halotolerans and Penicillium corylophilum by Internal Transcribed Spacer rDNA sequencing and β-tubulin gene sequencing. The patient was treated with liposomal amphotericin B followed by voriconazole, resulting in gradual clinical and radiologic improvement. Clinicians should consider fungal infection in patients with unexplained carotid artery occlusion and stroke. Submitting an adequate volume of CSF may improve the diagnostic yield for identifying the causative fungi.