To understand Trichoderma species infection association with spontaneous nontraumatic intracerebral hemorrhage. 

While Trichoderma species usually cause invasive fungal disease limited to pulmonary infections, endocarditis, peritonitis, CNS manifestations are extremely rare, and usually present in an immunocompromised host. Here, we present an atypical presentation of a patient with CNS manifestations of Trichoderma infection. 

A 79-Year-Old immunocompetent female with history of mucking, swimming and diving in the lake, which may have been a source of environmental exposure, who presented with right sided weakness, right facial droop and aphasia. Initial CTH revealed acute lobular and irregular mixed density hematoma in left frontal lobe with multiple surrounding foci of acute hemorrhage & surrounding edema. Patient was taken emergently to OR for surgical decompression. Tissue cultures were positive for Trichoderma species & responded well to antifungal coverage. Follow up MRI brain revealed a nontraumatic left frontal intracerebral hemorrhage with small acute/subacute infarctions in the left basal/medial basal ganglia and hypothalamus. CT chest, abdomen & pelvis w/o findings suggestive of malignancy. Final fungal susceptibilities returned with Trichoderma species most closely related to Trichoderma citrinoviridae.

Despite being associated with multiple hemorrhagic conditions, there has been no prior reported cases of intracerebral hemorrhage secondary to Trichoderma species infection to the best of our knowledge. This case proposes that Trichoderma species should be considered as an infectious agent in the setting of spontaneous nontraumatic ICH.