Cerebral phaeohyphomycosis due to Rhinocladiella mackenziei (formerly Ramichloridium mackenziei): case presentation and literature review

J Infect Public Health. 2011 Jun;4(2):96-102. doi: 10.1016/j.jiph.2011.01.001. Epub 2011 May 25.


Rhinocladiella mackenziei (formerly Ramichloridium mackenziei), a causative agent of cerebral phaeohyphomycosis, is extremely rare and it is geographically limited to the Middle East. The organism has a predilection to cause brain infections and results in a grave prognosis with a high mortality rate. The current patient was admitted to a long term care facility with chronic respiratory failure and dependence on a mechanical ventilator. She later developed left sided weakness and a CT-scan of the brain revealed multiple variable sized hypodense, well-defined lesions with ring enhancement. A stereotactic needle aspiration of the largest lesion showed fungal hyphae. The final culture grew R. mackenzie. The patient was initially started on liposomal amphotericin B, then voriconazole and caspofungin intravenously as posaconazole was not available. The patient failed to respond to antifungal therapy and finally she died 34 days after the start of the treatment. R. mackenziei is a highly virulent agent, and should be considered in the differential diagnosis of central nervous system disease in patients from the Middle East.

Publication types

  • Case Reports

MeSH terms

  • Antifungal Agents / administration & dosage
  • Ascomycota / isolation & purification*
  • Biopsy, Fine-Needle
  • Brain / diagnostic imaging
  • Brain / microbiology*
  • Brain / pathology*
  • Central Nervous System Fungal Infections / diagnosis*
  • Central Nervous System Fungal Infections / drug therapy
  • Central Nervous System Fungal Infections / microbiology
  • Fatal Outcome
  • Female
  • Humans
  • Microscopy
  • Middle Aged
  • Middle East
  • Respiration, Artificial / adverse effects
  • Respiratory Insufficiency / therapy
  • Tomography, X-Ray Computed


  • Antifungal Agents