An Intratumoral Phaeohyphomycotic Abscess in a Chemotherapy-Naive IDH-Mutant Glioma: A Mere Coincidence?

Phaeohyphomycotic agents causing central nervous system (CNS) infection is rare and is known to affect immunocompetent individuals. We present a patient with a CNS phaeohyphomycotic abscess that had developed within a temporal lobe glioma. Magnetic resonance imaging (MRI) performed two months prior to the surgery showed only the presence of a neoplasm. However, a repeat MRI in the immediate pre-operative period revealed an additional, likely fungal, lesion. During this interval of 2 months, the patient had received a short course of steroids for suspected encephalitis. The steroid therapy and the CNS tropism of the fungi could have contributed to the CNS mycosis. The intratumoral localization of the fungi could be attributed either to the altered tumour vasculature or to a mere coincidence. Occurrence of CNS mycosis within a high grade glioma is exceedingly rare. A majority of such patients reported in the literature had received chemotherapy for the glioma.