Chainsaw culture: Cladophialophora bantiana cerebral abscess after chainsaw activity in an immunocompetent host. Illustrative case.

BACKGROUND: Intracranial fungal infections in immunocompetent individuals are rare entities. Cladophialophora bantiana is a neurotropic phaeohyphomycete with a mortality of up to 70%. This is the second published case of intracranial C. bantiana from Australia. OBSERVATIONS: A 36-year-old immunocompetent female was referred to a tertiary metropolitan Australian hospital with a 5-day history of right upper and lower limb weakness. Imaging showed a left frontoparietal 19 × 17 × 19-mm intra-axial mass with associated vasogenic edema, initially thought to be a tumor. C. bantiana was diagnosed on stereotactic biopsy. The patient was started on antifungal therapy and then proceeded to have a craniotomy for complete lesional exeresis. At 18 months, the patient has no evidence of disease relapse and has had an excellent neurological recovery. LESSONS: Infection should always be considered in the differential diagnosis of a CNS lesion. A detailed history including occupation and exposures can assist preoperatively to ensure appropriate microbiology specimens are collected and prioritized. Prognosis is optimized by combining surgical debulking with antifungal therapy. Surgical management is a delicate balance between maximal excision for prognosis versus functional preservation. Medical therapy is challenging due to a high rate of adverse events with liposomal amphotericin and achieving therapeutic voriconazole levels. https://thejns.org/doi/10.3171/CASE25938.