Cerebral phaeohyphomycosis caused by a dematiaceous scopulariopsis species

This report describes a rapidly fatal case of cerebral phaeohyphomycosis in a 33-year-old immunocompetent male. The infection presented as a single la rge lesion in the deep white matter of one temporal lobe, which was then re moved surgically. Histologic features observed in the lobectomy specimen we re characterized by perivascular sleeves of mononuclear cells accompanied b y hemorrhages. These were reminiscent of acute hemorrhagic leukoencephaliti s except for the presence of rare fungal organisms and sparse multinucleate d giant cells similar to those occurring in AIDS. During the four days foll owing surgery, a large focus of cerebritis with massive invasion of fungi d eveloped in each centrum semiovale around the ventriculostomy sites. Fungal culture of the brain obtained at autopsy grew an organism consistent with a Scopulariopsis species.