Homographiella aspergillata, a non-aspergillus mould, causing fungal granuloma involving the anterior cranial fossa in an immunocompetent individual

Dhara Shah 1, Roungmei S K Marak 1, Lily Pal 2, Rabi Narayan Sahu 3, Sanjay Bihari 4, Tapan N. Dhole*5.

Author address: 

1 Sanjay Gandhi Post Graduate Institute of Medical Sciences; Microbiology; 2 Department of Pathology; Sanjay Gandhi Post Graduate Institute of Medical Sciences; Pathology; 3 Sanjay Gandhi Post Graduate Institute of Medical Sciences; Neurosurgery; 4 Sanjay Gandhi Post Graduate Institute of Medical Sciences; 5 Department of Microbiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, India; Microbiology.

Abstract: 

Background: In recent years, the emergence of non-aspergillus moulds in brain infections has been
observed. Hormographiella aspergillata, a filamentous basidiomycete present in compost/sewage, has
previously been implicated in pneumonia, lung abscess, endocarditis and keratomycosis in patients.
Case Report: Forty-year old immunocompetent female presented with anosmia, headache, bilateral
vision loss, vomiting, impaired olfaction/visual acuity, right optic atrophy without any facial
hypoesthesia/asymmetry. Radiological investigations revealed large basifrontal mass lesions in
anterior cranial fossa, involving ethmoid & sphenoid sinuses, right cavernous sinus & optic nerve.
Bilateral frontal craniotomy/total excision of mass was performed and multiple tissue pieces from
olfactory groove mass were sent for laboratory investigations.
Material/methods: Tissue pieces were homogenized and processed for KOH wet mount direct
microscopy and culture on Sabouraud’s Dextrose Agar (SDA)(250C,370C).

Results: Direct microscopy showed plenty hyaline septate fungal hyphae. Culture showed white-to creamcolored
cotton-like colonies with white mycelia tufts & irregular margin after 11 days of incubation.
Lactophenol cotton blue mount showed hyaline hyphae, septate simple/sympodially branched
conidiophores, apically bearing a cluster of conidiogenous hyphae which are septate & disarticulating into
arthroconidia with smooth-walled, hyaline, cylindrical conidia aggregating in slimy heads; morphologically
identified as Homographiella aspergillata. Patient was treated successfully with voriconazole and
liposomal amphotericin B.
Conclusions: This is a rare case of H.aspergillata causing fungal granuloma of anterior cranial fossa in an
immunocompetent individual. With the continuous expanding spectrum of fungi causing invasive disease,
it is important to consider the clinical relevance of every fungus cultured from clinical samples for a
successful outcome.

2017

abstract No: 

P1467

Full conference title: 

27th European Congress of Clinical Microbiology and Infectious Diseases (2017, Vienna)
    • ECCMID 27th (2017)