Molly S. Walkenhorst

Background: Cladophialophora bantiana is a globally distributed dematiaceous mold which acts as an uncommon source of human infection. With a predilection for the central nervous system (CNS), this organism accounts for nearly half of all cerebral phaeohyphomycosis, with a mortality rate over 60%. Due to the rarity of this disease, treatment regimens are primarily based on retrospective reviews of case reports. The best clinical response occurred with a dual approach of surgical resection and antifungal therapy, though mortality rates remain high. Case Summary: A 68-year-old immunocompromised woman presented with imaging findings concerning for a neoplastic process, such as a glial neoplasm or CNS lymphoma. With microbiology, flow cytometry, and cytology of the cerebrospinal fluid negative and frozen section of the lesion favoring glial neoplasm, the scarce pigmented fungal hyphae on permanent sections were unexpected. Broad-range fungal DNA testing identified the organism as C. bantiana . Without further surgical resection, dual antifungal therapy was utilized to achieve clinical stability and return to pre-infection baselines. Conclusion: This is a rare case of a C. bantiana fungal brain abscess in an immunocompromised patient. Complete surgical resection was not possible; however, this case provides additional data to show the benefits of a dual antifungal treatment approach without additional surgical intervention, and the dosages used to achieve stability at 18 months post-presentation. This case highlights the importance of prompt efforts in determining causative organisms in unexpected fungal brain abscesses, which allows for targeted and improved success in the treatment of this highly fatal disease.

Lipid keratopathy (LK) is a rare ophthalmological condition characterized by a progressive reduction in visual acuity caused by corneal opacification due to central lipid accumulation. LK is characterized by lipid deposits, cholesterol clefts, and neovascularization (NV) leading to disruption in corneal optical quality. LK classification includes a primary and secondary form which depend on pre-existing corneal or systemic disorders and the evidence of NV. Secondary LK is typically associated with a prior occurrence of herpetic infection, such as herpes zoster keratitis. Patients with LK usually present with progressive vision loss and dense cream-colored corneal opacification. Treatment modalities include conservative and surgical approaches focused on corneal NV elimination. When evaluating corneal lipidosis, it is crucial to consider a range of differential diagnoses, including corneal arcus, Schnyder corneal dystrophy, and other corneal deposit conditions. We report a case of a 62-year-old male with herpes zoster keratitis complicated with LK. He presented with painless progressive vision loss and corneal scarring, which raised suspicion about LK diagnosis. This paper emphasizes the importance of correlating clinical and histological findings for accurate LK diagnosis.