Subcutaneous phaeohyphomycosis due to cladophialophora bantiana: a first case report in an immunocompetent patient in Latin America and a brief literature review

Abstract We report a rare case of subcutaneous phaeohyphomycosis caused by Cladophialophora bantiana in an immunocompetent patient in Amazonas, Brazil. This dematiaceous fungus has been mainly associated with life-threatening infections affecting the central nervous systems of immunosuppressed patients. We present the clinical, laboratory, and therapeutic aspects, and in vitro susceptibility test results for different antifungal drugs. A brief review of the cases reported in the literature over the past 20 years has also been discussed. According to the literature review, the present case is the first report of subcutaneous phaeohyphomycosis due to C. bantiana in an immunocompetent patient in Latin America.

Feohifomicosis, una infección fúngica oportunista emergente / Phaeohyphomycosis, an emerging opportunistic fungal infection

Las feohifomicosis comprenden un grupo de infecciones causadas por hongos pigmentados, negros o dematiáceos. En las últimas dos décadas se ha incrementado la frecuencia de reportes y la diversidad de los agentes etiológicos implicados, especialmente en los individuos inmunosuprimidos. Los principales géneros involucrados incluyen Alternaria, Bipolaris, Cladophialophora y Exophiala. Estos hongos típicamente se encuentran en el suelo y son introducidos al cuerpo a través de la inhalación o el trauma. El espectro de las enfermedades asociadas también se ha ampliado e incluye infecciones cutáneas superficiales y profundas, enfermedad alérgica, neumonía, abscesos cerebrales e infección diseminada. El diagnóstico de laboratorio está basado en las características morfológicas de los agentes según lo observado en el examen microscópico directo y la histopatología. El tratamiento es a menudo difícil y depende del síndrome clínico. No hay terapias estandarizadas, pero voriconazol, posaconazol e itraconazol han demostrado la actividad in vitro más consistente contra este grupo de hongos. La rareza de estas micosis justifica describir las características clínicas, epidemiológicas y diagnósticas para ayudar a un reconocimiento inmediato y un tratamiento oportuno

Phaeohyphomycosis comprises a group of infections caused by black pigmented or dematiaceous fungi. In the last two decades the frequency of reporting and diversity of etiologic agents involved have increased, especially in immunosuppressed individuals. The main genera involved include Alternaria, Bipolaris, Cladophialophora and Exophiala. These fungi are typically found in the soil and introduced through inhalation or trauma. The spectrum of associated diseases also has broadened and includes superficial and deep cutaneous infections, allergic disease, pneumonia, brain abscess and disseminated infection. The laboratory diagnosis is based on the morphological characteristics of the agents as observed by direct microscopic examination and histopathology. Treatment is often challenging and depends uponthe clinical syndrome. There are no standardized therapies but voriconazole, posaconazole and itraconazole demonstrate the most consistent in vitro activity against this group of fungi. The rarity of this mycosis justifies describe the clinical, epidemiological and diagnostic characteristics to aid in its immediate recognition and early treatment

Subcutaneous Phaeohyphomycosis Caused by Phaeoacremonium Species in a Kidney Transplant Patient: The First Case in Korea / 대한진단검사의학회지

Phaeohyphomycosis is a subcutaneous infection caused by dark pigmented fungi, including fungi of the species Phaeoacremonium, Alternaria, Exophiala, and Pyrenochaeta. In August 2005, a 54-yr-old man who had received a renal transplant 5 yr ago was admitted to our hospital with a subcutaneous mass on the third finger of the right hand; the mass had been present for several months. He had been receiving immunosuppressive agents for several years. He underwent excision of the mass, which was followed by aspiration of the wound for bacterial and fungal cultures. Many fungal hyphae were observed on the histology slide treated with periodic acid-Schiff stain. A few white waxy colonies with a woolly texture grew on the Sabouraud dextrose agar at 30degrees C and changed to dark brown in color. Nucleotide sequencing of internal transcribed spacer regions revealed 100% homology to the Phaeoacremonium aleophilum anamorph and Togninia minima teleomorph (514 bp/514 bp). The patient completely recovered after wide surgical excision. Here, we report the first case of phaeohyphomycosis caused by Phaeoacremonium species in a kidney transplant patient in Korea.

Subcutaneous phaeohyphomycosis due to Exophiala spinifera in an immunocompromised host.

A case of phaeohyphomycosis presenting as multiple subcutaneous abscesses in a young lady with deteriorating liver function was reported here. The lesion started as a solitary abscess in the neck, mimicking tuberculous cold abscess and rapidly involved the face, chest, arms, and legs within six months with ulceration and discharge of thick brownish foul smelling pus. Potassium hydroxide mount of pus from various sites revealed septate dematiaceous hyphae and pseudohyphae. Culture yielded pure growth of Exophiala spinifera. Tissue debridement was done along with initiation of antifungal therapy with ketoconazole. As liver function deteriorated, antifungal therapy was withdrawn after seven days. Patient expired three weeks after admission due to hepatic failure.

Feohifomicosis subcutánea / Subcutaneous Phaeohyphomycosis

Se presenta un caso de Feohifomicosis subcutánea en un paciente joven inmunocompetente, localizada en cara flexora de antebrazo derecho, sin antecedente previo de traumatismo evidenciado por él mismo. Al examen físico presentaba lesiones nodulares y supurativas que al biopsiarlas evidenciaron intensa inflamación granulomatosa, con sectores de fibrosis y extensas áreas de necrosis. Luego se realizaron cultivos y estudios micológicos específicos, dando como diagnóstico una Feohifomicosis subcutánea por Exophiala dermatitidis. El tratamiento consistió en administración de itraconazol más resección quirúrgica completa, sin evidenciar recidivas a los seis meses del control posterior al tratamiento.

In this case we have examined a young male immunocompetent patient suffering from subcutaneous phaeohyphomycosis on his right forearm. Upon questioning, the patient did not express having noticed any previous traumatism. Physical examination revealed suppurative nodular lesions which, in the histologic study, showed severe granulomatous inflammation along with fibrotic tissue and necrosis. We carried out the corresponding cultures, the results of which was Exophila dermatitidis, and subcutaneous phaeohyphomycosis was diagnosed. The treatment of choice consisted in itraconazole and a surgical procedure to remove the lesion. Six months after the procedure, we have found no sings of the disease.

A Case of Primary Subcutaneous Phaeohyphomycosis Caused by Drechslera Dematioidea / 대한피부과학회지

Phaeohyphomycosis refers to subcutaneous and systemic fungal infections characterized by dematiacious septate mycerial elements in tissue, We are discribing the first report of subcutaneous phaeohyphomycosis by Drechslera dematioidea in a 9-year-old boy who presented a slow-growing 4x5.5cm erythematous plaque with somewhat verrucous and eczematous lesion on the dorsal aspect of his right foot after receiving a burn by boiling liquid at 2 years of age. Biopsy of the lesion revealed granulomatous inflammation, brownish spores in chain and planate-deviding sclerotic bodies in the epidermis and upper dermis. Findings by microscopic examination and consecutive cultures of scales and biopsy specimen were consistent with Drechslera dematioidea. The lesion was successfully treated with itraconazole.