Cerebral abscesses caused by dark-pigmented Fonsecaea fungi are rare, especially in otherwise healthy individuals. In this case report, we present a 61-year-old man from Moldova, living in the Czech Republic, who had worked as a locksmith on oil platforms in Turkmenistan, Kazakhstan, Sudan, and Iraq since 1999, and was admitted to a neurology ward for a sudden motion disorder of the right leg, dysarthria, and hypomimia. Imaging revealed presence of expansive focus around the left lateral ventricle of the brain and a pronounced peripheral edema. The intracranial infectious focus was excised under intraoperative SonoWand guidance. Tissue samples were histologically positive for dark-pigmented hyphae, suggesting dematiaceous fungi. Therefore, liposomal amphotericin B therapy was initiated immediately. Fonsecaea monophora was provisionally identified using ITS rDNA region sequencing directly from brain tissue. The identification was subsequently confirmed by cultivation and DNA sequencing from culture. The strain exhibited in vitro sensitive to voriconazole (MIC = 0.016 μg/mL) and resistance to amphotericin B (MIC = 4 μg/mL); therefore, the amphotericin B was replaced with voriconazole. Postoperatively, a significant clinical improvement was observed and no additional surgery was required. Based on the literature review, this is the third documented case of cerebral infection due to this pathogen in patients without underlying conditions and the first such case in Europe.

Department of Bacteriology and Mycology Institute of Public Health in Ostrava Ostrava Czech Republic

Department of Biomedical Science Faculty of Medicine University of Ostrava Ostrava Czech Republic

Department of Botany Faculty of Science Charles University Prague Czech Republic

Department of Infectious Diseases Uherske Hradiste Hospital Uherske Hradiste Czech Republic

Department of Microbiology Faculty of Medicine and Dentistry Palacky University Olomouc Olomouc Czech Republic

Department of Molecular Biology Institute of Public Health in Ostrava Ostrava Czech Republic

Department of Parasitology Mycology and Mycobacteriology Prague Public Health Institute in Usti nad Labem Prague Czech Republic

Department of Rehabilitation Faculty of Medicine University of Ostrava Ostrava Czech Republic

Laboratory of Fungal Genetics and Metabolism Institute of Microbiology of the AS CR Prague Czech Republic

Neurosurgery Tomas Bata Regional Hospital Zlin Czech Republic

Pathological and Anatomical Department Tomas Bata Regional Hospital Zlin Czech Republic

Radiodiagnostic Department Uherske Hradiste Hospital Uherske Hradiste Czech Republic

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