A Rare Case of Cladophialophora Isolated in a Renal Transplant Patient after Rejection Therapy

Abstract

Cladophialophora bantiana is the most common cause of cerebral phaeohyphomycosis. A case of live-related renal allograft recipient complained of high-grade continuous fever on the 5th postoperative day (POD). No organism was isolated on cultures and no foci were found on chest X-ray. He was started on broad-spectrum antibiotics. The patient thereafter developed acute antibody-mediated plus acute cellular rejection on the 7th POD. He received a high dose methylprednisolone with plasmapheresis. On the 18th POD, the patient was diagnosed with right frontotemporal and basal ganglionic region abscess on magnetic resonance imaging of the brain. Urgent neurosurgical intervention was done and the sample was sent for investigation. Initially, there was suspicion of Aspergillus on culture. Injection of liposomal amphotericin B was given for 14 days, after which oral voriconazole was started. The patient improved initially but multiple abscesses recurred on the 46th POD. Abscess was drained. On the final culture report, C. bantiana was isolated. 5-flucytosine was added to voriconazole as dual antifungal therapy.