A fatal case of disseminated Cladophialophora bantiana infection in a renal transplant recipient

Dematiaceous molds often cause noninvasive disease but have the potential to cause disseminated infection, particularly in immunosuppressed hosts. Cladophialophora bantiana is the most neurotropic of dematiaceous molds and is associated with brain abscesses, but disseminated infection is quite rare. Here we present a case of disseminated C. bantiana in a 67-year-old renal transplant recipient with multifocal soft tissue, bone and presumed central nervous system involvement. C. bantiana infections have been associated with significant mortality and our patient had progression of his disease despite intensive dual antifungal therapy with close therapeutic drug monitoring. There was a delay in diagnosis and initiation of antifungal therapy as the multifocal disease was presumed to represent a malignant process. This case review highlights the importance of having a high index of suspicion for disseminated fungal infection in immunocompromised patients and the need for tissue biopsy to aid in the prompt and timely diagnosis and initiation of empiric antifungal therapy, with concomitant surgical management whenever possible to improve patient outcomes.