Ramichloridium mackenziei is a dematiaceous fungus that usually causes cerebral phaeohyphomycosis. We describe the aspiration cytology findings of a case of cerebral abscess caused by R. mackenziei in a 66-yr-old Saudi woman who had a long standing history of diabetes mellitus and a recent diagnosis of systemic lupus erythematosus. She was on long-term corticosteroid therapy. The patient developed rapidly progressive multiple brain abscesses and died despite aspiration of the abscess and administration of intravenous amphotericin B lipid complex and voriconazole.

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