Utility of liquid biopsy in diagnosing isolated cerebral phaeohyphomycosis: illustrative case

Annie E. Arrighi-Allisan, Monica M. Vidaurrazaga, Vincent B. De Chavez, Clare H. Bryce, John W. Rutland, Alberto E. Paniz-Mondolfi, Emilia M. Sordillo, Michael D. Nowak, Melissa R. Gitman, Risa Fuller, Emily Baneman, Raymund L. Yong

Research output: Contribution to journalArticlepeer-review

5 Scopus citations

Abstract

BACKGROUND Cladophialophora bantiana is a dematiaceous, saprophytic fungus and a rare but reported cause of intracranial abscesses due to its strong neurotropism. Although it predominantly affects immunocompetent individuals with environmental exposure, more recently, its significance as a highly lethal opportunistic infection in transplant recipients has been recognized. Successful treatment requires timely but often challenging diagnosis, followed by complete surgical excision. Next-generation sequencing of microbial cell-free DNA (cfDNA) from plasma is a novel diagnostic method with the potential to identify invasive fungal infections more rapidly and less invasively than conventional microbiological testing, including brain biopsy. OBSERVATIONS The authors described the case of a recipient of a liver transplant who presented with seizures and was found to have innumerable ring-enhancing intracranial lesions. The Karius Test, a commercially available method of next-generation sequencing of cfDNA, was used to determine the causative organism. Samples from the patient’s plasma identified C. bantiana 6 days before culture results of the surgical specimen, allowing optimization of the empirical antifungal regimen, which led to a reduction in the size of the abscesses. LESSONS The authors’ findings suggest that microbial cfDNA sequencing may be particularly impactful in improving the management of brain abscesses in which the differential diagnosis is wide because of immunosuppression.

Original languageEnglish
Article numberCASE21557
JournalJournal of Neurosurgery: Case Lessons
Volume3
Issue number5
DOIs
StatePublished - Jan 2022

Keywords

  • brain abscess
  • immunosuppression
  • invasive fungal infection
  • neurosurgery
  • next-generation sequencing

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