Poster session 2, September 22, 2022, 12:30 PM - 1:30 PM Objective: Dematiaceous or melanized fungi, can cause CNS involvement even in apparently immunocompetent hosts because of the intense neurotropism of the fungus. We present a series of 4 such cases. Methods Case series Results Figs. 1 and 2 Conclusion The diagnosis of the disease is challenging due to its rarity, lack of specific signs and symptoms, and radiological findings of the disease. Radiologic reports should give a DD rather than name a specific condition. This prevents a biopsy procedure and leads to the use of empiric, ineffective, toxic, expensive therapy and disease progression. In our case series, the mean days to diagnosis from symptom onset was 49 days. Although, less than what is reported in the literature which is 115 days, it is still late to be of meaningful value to the patient. There are many factors like antifungal DST, interpretation of MIC when there is no BP available, cost of antifungal therapy, therapeutic drug monitoring, need for repeat surgery, active follow-up, and awareness among surgical colleagues remain a major concern in Indian settings. Combination of antifungal drugs for life long along with wide surgical resection with frequent follow-ups which includes TDM, radiological assessment, need for repeat surgery, and management of adverse drug reactions of antifungal drugs are the unmet clinical needs.

Cladophialophora bantiana is a rare melanized neurotropic fungus. We report a case of cerebral pheohyphomycosis due to C. bantiana in an immunocompetent child. The patient was a 12-year-old male who presented with a headache, intermittent vomiting associated with decreased movements of the right upper and lower limbs, and right-sided deviation of the mouth. Brain magnetic resonance imaging showed multiple conglomerated lesions in the left gangliocapsular region and corona radiata with perilesional edema and mass effect and a few small ring-enhancing lesions also. Aspiration of brain abscess sent for a culture and isolated C. bantiana. The clinical and radiological presentations are similar to the common organisms such as tuberculosis and thus can be misleading while diagnosis. Despite aggressive management, the patient succumbed to his illness. It is imperative to isolate microorganisms, using all microbiological tests. Fungi should also be considered irrespective of the immunocompetency.