BACKGROUND AND IMPORTANCE: Cerebral phaeohyphomycosis caused by Cladophialophora bantiana carries a high mortality rate of approximately 70%. Prompt, complete resection is associated with improved patient outcomes, with surgeons typically relying on imaging for appropriate margins of resection. 5-aminolevulinic acid (5-ALA) has traditionally been used in patients with gliomas; however, when used in our case of a patient with C. bantiana mimicking glioma, 5-ALA illuminated the capsule, allowing for optimal excision. CLINICAL PRESENTATION: An 81-year-old immunocompetent woman presented with dizziness, gait imbalance, headache, and left homonymous hemianopsia and was found to have right occipital hyperintensity concerning for malignancy. Subsequent craniotomy with 5-ALA fluorescence was performed, and the capsule was fully resected. On histopathological analysis, the sample revealed C. bantiana . Infectious disease was consulted, and the patient was treated with appropriate antifungals. Postoperatively, the fungus has completely resolved with no reported complications. CONCLUSION: C. bantiana is a fungal infection with high mortality and poor prognosis, capable of invading immunocompetent hosts. In our case, the intraoperative use of 5-ALA allowed for optimal surgical excision and no postoperative complications to date. This study suggests that 5-ALA could be used in situations not restricted to glioma to promote decreased mortality and improved patient outcomes.
Mitchell et al. (Wed,) studied this question.