Cerebral phaeohyphomycosis caused by Ramichloridium obovoideum (Ramichloridium mackenziei): case report

Neurosurgery. 1999 Aug;45(2):372-5. doi: 10.1097/00006123-199908000-00034.


Objective and importance: Only a few cerebral infections with the dark-walled mold Ramichloridium obovoideum (Ramichloridium mackenziei) have been reported in the literature. Central nervous system infections caused by this fungus have poor prognoses; the optimal medical and surgical treatments have not yet been established. We report a case of cerebral R. obovoideum infection for which a combination of medical and surgical treatments failed.

Clinical presentation: A 58-year-old Kuwaiti woman, with a history of chronic renal failure requiring hemodialysis, presented with a 3-day history of left frontal headache, blurry vision, dizziness, and right-sided clumsiness. Computed tomography demonstrated multiple, ring-enhancing, cerebral lesions (the largest of which measured 2-3 cm) in the deep left parieto-occipital region.

Intervention: A computed tomography-guided needle biopsy of the parieto-occipital lesion yielded 10 ml of dark caseous fluid. Stains demonstrated long, branching, septate hyphae. Fungal cultures grew R. obovoideum. The patient was treated with a combination of amphotericin B and itraconazole. The condition of the patient continued to deteriorate, and stereotactic aspiration of the largest lesion was performed. Despite this approach, the lesion progressed and the patient died.

Conclusion: R. obovoideum is being increasingly recognized as a cause of cerebral abscesses in patients residing in the Middle East. Prognoses are poor, and responses to antifungal therapy are generally short-lived. Until more effective therapies are found, the greatest chance for adequate treatment involves early recognition, prompt treatment with antifungal agents, and attempts at complete resection.

Publication types

  • Case Reports

MeSH terms

  • Amphotericin B / therapeutic use
  • Antifungal Agents / therapeutic use
  • Brain Diseases / diagnosis
  • Brain Diseases / drug therapy
  • Brain Diseases / microbiology*
  • Brain Diseases / surgery
  • Drainage
  • Fatal Outcome
  • Female
  • Humans
  • Itraconazole / therapeutic use
  • Magnetic Resonance Imaging
  • Middle Aged
  • Mitosporic Fungi* / isolation & purification
  • Mycoses / drug therapy
  • Mycoses / microbiology*
  • Mycoses / surgery


  • Antifungal Agents
  • Itraconazole
  • Amphotericin B