Rhinocladiella similis a rare cause of chronic recurrent lymphocytic meningitis- a case report

Phaeohyphomycosis is a rare but frequently fatal fungal infection caused by neurotropic black fungi belonging to the ascomycete order Chaetothyriales: Cladophialophora species, Rhinocladiella species and Exophiala dermatitidis. An 8 year boy old presented with recurrent headache and fever, lumbar puncture done thrice over the course of 3 months. CSF cytology was consistent with lymphocytic pleocytosis, raised protein and hypoglycorrhachia. CSF was subjected to panfungal DNA detection by PCR followed by fungal identification by DNA sequencing. The assay targets multicity genes, the ribosomal DNA (rDNA) genes (18S, 28S, and 5.8S) and the intervening internal transcribed spacer (ITS) regions (ITS1 and ITS2). Initial CSF sample submitted identified the etiologic agent as Rhinocladiella similis since it presented sequence identity at 99% and coverage at 100% with total score of 1000. As Rhinocladiella species are rare cause of chronic recurrent lymphocytic meningitis we had requested to submit repeat CSF specimens. Subsequent CSF sample submitted, identified the same etiologic agent on DNA sequencing. Here we present an unusual case of Rhinocladiella similis, a rare cause of chronic recurrent lymphocytic meningitis.