We report a case of cerebral phaeohyphomycosis caused by a dematiaceous fungus, Fonsecaea monophora, in a patient with type 2 diabetes mellitus and decompensated chronic liver disease. CT brain revealed a 2x2cm hypodense cystic lesion in the right lentiform nucleus region with significant perilesional edema. Stereotactic burr hole aspiration of the lesion with biopsy of the abscess wall was done, and the aspirated pus from the lesion showed branched, septate hyphae with light brown pigmentation. The culture of the pus grew a dematiaceous fungus, identified by morphological and molecular studies as Fonsecaea monophora. The isolate was susceptible to voriconazole (MIC, 0.004 µg/ml) but showed reduced susceptibility to amphotericin B (MIC, four µg/ml). The patients caregivers were not willing for a decompressive procedure and hence was treated medically with combined Amphotericin B and voriconazole antifungal therapy. Ultimately, the patient expired due to raised intracranial tension and resultant brain-stem dysfunction. It is the first case of cerebral phaeohyphomycosis caused by Fonsecaea monophora reported from India.
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