Sino-Cranial Infection Caused by Curvularia spicifera in a Young Adult Without Overt Immunosuppression: A Case Report and Review of the Literature

Curvularia species are melanized dematiaceous molds widely distributed in soil, plants, and decaying organic matter. Human infections are uncommon and typically involve the paranasal sinuses, skin, cornea, or respiratory tract, whereas central nervous system (CNS) involvement is rare. We report a locally invasive sino-cranial infection caused by Curvularia spicifera in a 20-year-old immunocompetent man with chronic sinusitis and features consistent with allergic fungal rhinosinusitis (AFRS). Brain magnetic resonance imaging revealed acute-on-chronic sinusitis complicated by a frontal sinus mucocele with orbital and intracranial extension. Management involved urgent neurosurgical source control followed by endoscopic sinonasal surgery. C. spicifera was repeatedly isolated from independent deep surgical specimens. The isolate was identified as Curvularia spicifera using a polyphasic approach integrating morphological, proteomic (MALDI-TOF MS), and molecular evidence. Histopathological examination demonstrated mixed neutrophilic and eosinophilic inflammation consistent with AFRS. Antifungal treatment was initiated with liposomal amphotericin B plus voriconazole; amphotericin B was subsequently discontinued because of severe hypokalemia, whereas voriconazole was continued under therapeutic drug monitoring. At the time of writing, the patient had completed three months of voriconazole therapy, with progressive clinical improvement and good tolerability, and was awaiting further radiological follow-up to guide the decision on treatment duration. Review of published cases indicates that contiguous spread from chronic sinonasal disease represents a frequent pathogenic mechanism of CNS Curvularia infection and that severe disease may occur even in the absence of overt immunosuppression. This case highlights the importance of early multidisciplinary management, aggressive surgical source control, accurate microbiological identification, and prolonged mold-active antifungal therapy with careful monitoring for treatment-related toxicity.