Cerebral phaeohyphomycosis caused by Fonsecaea monophora

We report a case of cerebral phaeohyphomycosis in a 53-year-old immunocompetent diabetic male, caused by Fonsecaea monophora. Computerized tomography of the brain revealed an abscess, which yielded F. monophora in pure culture. The patient's condition deteriorated on treatment with voriconazole and 5-fluorocytosine, and improved subsequently with high-dose itraconazole. The genus Fonsecaea has recently been revised and the new species F. monophora generated from molecular analysis of isolates, most of which were originally identified as Fonsecaea pedrosoi. This is the fourth case of cerebral infection known to have been caused by F. monophora, although only the first reported as such. These cases suggest that the clinical potential of F. monophora differs from that of F. pedrosoi, one of the main agents of chromoblastomycosis, with F. monophora being predominantly neurotropic in the human host.