Soni A, Yamala N, Krishnan G, Attilli H, Mittal H. Coexisting phaeohyphomycosis and tubercular central nervous system infections in an immunocompetent child: A case report. World J Clin Pediatr 2026; 15(4): 120132 [DOI: 10.5409/wjcp.120132]
Corresponding Author of This Article
Hema Mittal, Department of Pediatrics, Dr. Ram Manohar Lohia Hospital, New Delhi 110001, India. hema_g10@hotmail.com
Research Domain of This Article
Infectious Diseases
Article-Type of This Article
case-report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
Share the Article
Soni A, Yamala N, Krishnan G, Attilli H, Mittal H. Coexisting phaeohyphomycosis and tubercular central nervous system infections in an immunocompetent child: A case report. World J Clin Pediatr 2026; 15(4): 120132 [DOI: 10.5409/wjcp.120132]
World J Clin Pediatr. Dec 9, 2026; 15(4): 120132 Published online Dec 9, 2026. doi: 10.5409/wjcp.120132
Coexisting phaeohyphomycosis and tubercular central nervous system infections in an immunocompetent child: A case report
Anil Soni, Nikhil Yamala, Gayatri Krishnan, Harika Attilli, Hema Mittal
Anil Soni, Nikhil Yamala, Gayatri Krishnan, Harika Attilli, Hema Mittal, Department of Pediatrics, Dr. Ram Manohar Lohia Hospital, New Delhi 110001, India
Author contributions: Soni A contributed to case management, detailed literature review, conceptualisation of case report, writing manuscript; Yamala N, Krishnan G, and Attilli H contributed to patient care, Literature review; Mittal H contributed to chief physician involved in patient care, management plan, supervised literature review and approved final manuscript.
Informed consent statement: Written informed consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: All authors declare that they have no conflict of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Corresponding author: Hema Mittal, Department of Pediatrics, Dr. Ram Manohar Lohia Hospital, New Delhi 110001, India. hema_g10@hotmail.com
Received: February 24, 2026 Revised: March 15, 2026 Accepted: April 20, 2026 Published online: December 9, 2026 Processing time: 216 Days and 20.6 Hours
Abstract
BACKGROUND
Diagnosing chronic meningitis is a clinical challenge. Infection with cerebral phaeohyphomycosis, caused by dematiaceous (melanized) fungi, is extremely rare but is a life-threatening cerebral abscess. It presents with non-specific signs and symptoms and carries a poor prognosis, regardless of the patient’s immune status. In endemic regions, it closely mimics common conditions such as tuberculous meningitis or intracranial tuberculomas, complicating timely diagnosis and management.
CASE SUMMARY
We present the case of 10-year-old immunocompetent child who was admitted with fever, headache, and meningeal signs. Initial neuroimaging revealed multiple ring-enhancing, conglomerated lesions with perilesional oedema in left temporo-parietal region. Cerebrospinal fluid analysis showed pleocytosis with lymphocytic predominance and highly raised protein levels. Based on clinical-radiological findings and the regional prevalence of tuberculosis (TB), child was initially diagnosed and treated as a case of central nervous system TB with standard anti-tubercular therapy (ATT) & adjunctive steroids. After 5-6 weeks, the patient was readmitted with worsening raised intracranial pressure. Repeat neuroimaging revealed an increase in abscess size along with oedema. Craniotomy with evacuation of the abscess was performed. Direct microscopy of aspirated pus showed pigmented, septate fungal hyphae consistent with phaeohyphomycosis. Histopathological examination also demonstrated features of coexisting tubercular pathology. Child was treated with combined antifungal therapy (liposomal amphotericin B) for 6 weeks and ATT, resulting in clinical and radiological improvement.
CONCLUSION
Case highlights the diagnostic dilemma posed by cerebral phaeohyphomycosis, particularly in regions endemic for TB. It emphasizes the need to consider alternative or dual infections in paediatric patients with poor response to standard treatments. Early suspicion, prompt surgical intervention, and targeted medical therapy are critical for improving outcomes.
Core Tip: This report describes a rare dual central nervous system infection with phaeohyphomycosis and tuberculosis in an immunocompetent child. The case highlights diagnostic challenges, the importance of considering mixed infections even in healthy hosts, and the need for early combined antifungal and antitubercular therapy and surgical therapy to improve outcome.
