Aureobasidium melanogenum isolation from the cerebrospinal fluid of a patient with human immunodeficiency virus/acquired immunodeficiency syndrome: A novel report

Abstract

A 22-year-old Brazilian man with untreated ulcerative colitis and human immunodeficiency virus (HIV) infection was admitted to the intensive care unit (ICU) for holocranial headache, fever, nausea, malaise, and diarrhea. Antiretroviral therapy (ART) was discontinued eight months earlier. Medical history included prior hospitalization due to pneumomediastinum secondary to perforated esophageal moniliasis. Laboratory tests showed leukocytosis, elevated C-reactive protein levels, high HIV viral load (133.627 copies/mL), low CD4+T-cell count (14 cells/mm3), and abnormal levels of cerebrospinal fluid (CSF) proteins and glucose. Treatment with ceftriaxone, metronidazole, and mebendazole was initiated. Further CSF analysis was negative for Cryptococcus spp., but fungal culture showed the growth of black, rough colonies (Figure 1a) with conidia as observed by optical microscopy (Figure 1b). The fungus was identified as Aureobasidium melanogenum using gene sequencing. Treatment with amphotericin B lipid complex was initiated for 14 days, and he was discharged from the ICU after re-initiating ART.