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Rhinocladiella mackenziei cerebral phaeohyphomycosis with a definitive outcome
  1. Moneera Aldraihem1,
  2. Oweida Aldosary2,3,
  3. Weam Khalefah Almasaud1,
  4. Rewaa Nasser Alqurashi2 and
  5. Abdulrahman B Abu-Amara1
  1. 1Neurology, King Fahad Medical City, Riyadh, Saudi Arabia
  2. 2Internal Medicine, Infectious Diseases, King Fahad Medical City, Riyadh, Saudi Arabia
  3. 3Internal Medicine, Infectious Diseases, King Saud Medical City, Riyadh, Saudi Arabia
  1. Correspondence to Dr Moneera Aldraihem; Moneera.o.d{at}


A right-handed man in his early 60s with hypertension controlled by a single prescription medication presented with left-sided heaviness and intermittent right occipital headache. Initial diagnostic workup was unremarkable. CT revealed an enhancing lesion located in the right parietal lobe, with mild mass effect on the right occipital horn, indicative of a brain abscess. The patient was initially treated with a course of empirical antibiotics, including ceftriaxone, vancomycin, metronidazole and dexamethasone. The neurosurgery team aspirated the abscess the following day and extracted yellow pus that was sampled for bacterial and fungal cultures. These cultures returned positive for Rhinocladiella mackenziei, prompting a discontinuation of the empirical antibiotics and initiation of intravenous liposomal amphotericin B for 4 weeks. Intravenous posaconazole was added to the patient’s existing therapy regimen, which was substituted with oral isavuconazole on discharge. The patient continues to take isavuconazole, and follow-up imaging has demonstrated regression of the abscess.

  • Infectious diseases
  • Infection (neurology)

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  • Contributors All authors contributed to study design and conception, data collection and interpretation. MA and OA contributed to data analysis. MA wrote the first draft of the article. MA, WKA, RNA, Abdulrahman B Abu-Amara and OA reviewed, critiqued and edited the first draft and approved the final version for publication.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.