[[Phaeohyphomycosis]] causes a wide spectrum of systemic manifestations and can affect even the [[immunocompetent]] [[host]]s. Involvement of the [[central nervous system]] is rare. A 48-year-old farmer presented with chronic [[headache]], [[fever]], and impaired [[vision]] and hearing. Serial [[MRI]]s of the brain showed enhancing exudates in the [[basal cistern]]s, and lesions in the [[sella]] and perichiasmatic and [[cerebellopontine angle]] regions along with enhancement of the [[cranial nerve]]s and [[leptomeninge]]s. [[Cerebrospinal fluid]] (CSF) showed lymphocytic [[pleocytosis]] with elevated [[protein]] and decreased [[glucose]] on multiple occasions. Clinical, imaging, and CSF abnormalities persisted despite treatment with antitubercular [[drug]]s and [[steroid]]s for 2 years. [[Biopsy]] of the dura mater at the cervicomedullary junction revealed necrotizing granulomatous lesions, neutrophilic abscesses, and giant cells containing slender, pauci-septate, pigmented fungal hyphae. Fungal culture showed growth of [[Fonsecaea pedrosoi]], which is classically known to cause [[brain abscess]]es. 

Hesarur et al. reported the diagnostic odyssey in a patient with chronic [[meningitis]] from a region endemic for [[tuberculosis]] and describe the challenges in establishing the accurate diagnosis. Lack of therapeutic response to an adequate trial of empirical antitubercular therapy warrants search for alternative causes, including [[fungal meningitis]]. They highlighted the uncommon manifestation of F. pedrosoi with chronic meningitis as well as the protracted clinical course despite not receiving antifungal therapy
((Hesarur N, Seshagiri DV, Nagappa M, et al. Case Report: Chronic Fungal Meningitis Masquerading as Tubercular Meningitis [published online ahead of print, 2020 Aug 31]. Am J Trop Med Hyg. 2020;10.4269/ajtmh.19-0885. doi:10.4269/ajtmh.19-0885)).