Cerebral abscess, phaeohyphomycosis, immunocompetent patient, micro-surgery, antimycotic therapy Cerebrální absces, feohyfomykóza, imunokompetentní pacient, mikrochirurgie, antimykotická terapie

Cerebral abscesses caused by dark-pigmented Fonsecaea fungi are rare, especially in otherwise healthy individuals. In this casereport, we present a 61-year-old man from Moldova, living in the Czech Republic, who had worked as a locksmith on oilplatforms in Turkmenistan, Kazakhstan, Sudan, and Iraq since 1999, and was admitted to a neurology ward for a sudden motiondisorder of the right leg, dysarthria, and hypomimia. Imaging revealed presence of expansive focus around the left lateralventricle of the brain and a pronounced peripheral edema. The intracranial infectious focus was excised under intraoperativeSonoWand guidance. Tissue samples were histologically positive for dark-pigmented hyphae, suggesting dematiaceous fungi.Therefore, liposomal amphotericin B therapy was initiated immediately. Fonsecaea monophora was provisionally identifiedusing ITS rDNA region sequencing directly from brain tissue. The identification was subsequently confirmed by cultivation andDNA sequencing from culture. The strain exhibited in vitro sensitive to voriconazole (MIC = 0.016 ?g/mL) and resistance toamphotericin B (MIC = 4 ?g/mL); therefore, the amphotericin B was replaced with voriconazole. Postoperatively, a significantclinical improvement was observed and no additional surgery was required. Based on the literature review, this is the thirddocumented case of cerebral infection due to this pathogen in patients without underlying conditions and the first such case inEurope.