Cutaneous Phaeohyphomycosis Caused by Veronaea bothryosa in a Liver Transplant Recipient Successfully Treated with Itraconazole

Foulet, F.; Duvoux, Christophe; Bièvre, C. De; Hézode, C.; Bretagne, Stéphane

doi:10.1086/598660

Cited by 32 publications

(29 citation statements)

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“…The prepubertal age of the patient in the present case seems to have had some effect on the extensive spread of the lesions over various parts of his body. In the previously described four cases caused by V. botryosa (1,7,15,16; Medina et al, Proc. 4th China Japan Int.…”

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confidence: 95%

Subcutaneous Phaeohyphomycosis Caused byVeronaeabotryosain the People’s Republic of China

Matsushita

Ji-long²,

Hiruma

et al. 2003

J Clin Microbiol

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The second case of phaeohyphomycosis caused by Veronaea botryosa in China, in a 12-year-old boy from Jiangsu Province, is presented. Based on direct examination of the scrapings from crusted lesions; histologic examination of the biopsy tissue showing septate, phaeoid hyphal elements; and the culture exhibiting sympodial, conidiogenous cells producing predominantly two-celled, cylindric conidia, the etiologic agent was identified as V. botryosa. CASE REPORTA 12-year-old boy from Jiangsu Province, China, received a seemingly innocuous scratch on his right elbow at the age of 6 years. Later, several 10-to 12-by 6-to 8-mm papules with exudates appeared sporadically on his extremities and became crusted. Within a period of 2 years, the infection had spread to other parts of the body-namely, face, hands, legs, scrotum, and buttocks-except for the chest and back (Fig. 1). The lesions became nodular, forming thick, crusted areas, especially on the patient's face, the backs of his hands, and the crural area. Adjacent lesions often coalesced to form plaques. Superficial lymph node swellings were not observed. The peripheral blood was found to be normal with positive HbsAg. No abnormal findings were noted in a urine test, chest X ray, and abdominal echo examination. Histopathologic and mycological examinations were out and the patient received treatment, including antifungal therapy, over a period of many months, without significant improvement. Effective treatment is still being sought.Histopathologic examination. Biopsy tissue slides were stained by the hematoxylin and eosin stain and periodic acid Schiff's reagent procedures. Microscopic examination of hematoxylin-and eosin-stained slides revealed hyperkeratosis and incrustation accompanying parakeratosis and containing neutrophils and yellow-brown-pigmented, septate hyphal elements of various lengths. The epidermis was thickened irregularly and showed pseudoepitheliomatous hyperplasia. High-density inflammatory cells were seen in the upper and middle layers of the dermis. Microabscesses, composed of neutrophil aggregates surrounding hyphal elements, were present, and a granulomatous reaction consisting of giant cells containing fungal hyphae was observed. The hyphal elements of various lengths were septate, branched, or unbranched and were pale brown (Fig. 2).Mycological examination. Microscopic examination of the scrapings from crust of the lesions in potassium hydroxide mounts showed numerous septate, branched, yellowish-brownpigmented hyphae 2.5 to 4.0 m in diameter. Scrapings from the crusty lesions and biopsy tissue were cultured on in-houseprepared nutritional media (3), namely, Sabouraud dextrose agar containing chloramphenicol (SabϩC) and SabϩC containing cycloheximide. The culture plates were incubated at 25 and 37°C in the dark and were observed every 2 days. Numerous velvety, olivaceous gray colonies were observed after 7 to 10 days of incubation on all plates. Bacterial and mycobacterial cultures were negative.A subculture of the isolate was studied in gre...

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confidence: 95%

Subcutaneous Phaeohyphomycosis Caused byVeronaeabotryosain the People’s Republic of China

Matsushita

Ji-long²,

Hiruma

et al. 2003

J Clin Microbiol

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“…and Phialophora spp. are the next most common fungi, followed by Cladosporium spp., Exserohilum spp., Veronaea botryosa, and many others with scattered case reports (7,12,19,23,32,36,56,61,65,81,140,143,194,209,230,241,251,258,306,313,342,362,365,369,387,413,418,421,457,469,482,486,487,495,539,559,556,568,571,576,590,609,613,614,646,659,694,699,720,728,…”

Section: Phaeohyphomycosismentioning

confidence: 99%

“…Patients for whom prolonged antifungal therapy is problematic may also benefit from this technique, such as transplant patients, who often are on immunosuppressive medications that interact with oral triazole antifungals. For multiple lesions where resection may be difficult, antifungal therapy alone has also been successful, even in immunocompromised patients (251,514). A variety of alternative therapies have been successfully employed as well, including cryotherapy, thermotherapy (local heat application), and supersaturated potassium iodide (SSKI) (286,313,751).…”

Section: Phaeohyphomycosismentioning

confidence: 99%

Melanized Fungi in Human Disease

2010

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SUMMARY Melanized or dematiaceous fungi are associated with a wide variety of infectious syndromes. Many are soil organisms and are generally distributed worldwide, though certain species appear to have restricted geographic ranges. Though they are uncommon causes of disease, melanized fungi have been increasingly recognized as important pathogens, with most reports occurring in the past 20 years. The spectrum of diseases with which they are associated has also broadened and includes allergic disease, superficial and deep local infections, pneumonia, brain abscess, and disseminated infection. For some infections in immunocompetent individuals, such as allergic fungal sinusitis and brain abscess, they are among the most common etiologic fungi. Melanin is a likely virulence factor for these fungi. Diagnosis relies on careful microscopic and pathological examination, as well as clinical assessment of the patient, as these fungi are often considered contaminants. Therapy varies depending upon the clinical syndrome. Local infection may be cured with excision alone, while systemic disease is often refractory to therapy. Triazoles such as voriconazole, posaconazole, and itraconazole have the most consistent in vitro activity. Further studies are needed to better understand the pathogenesis and optimal treatment of these uncommon infections.

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“…The latest case described involves a hepatic transplant recipient in France, from 1996. 6 Recently, Polish researchers found this fungus in the water and snow in coniferous trees. 7 The present report is the first of its kind on the American continent.…”

Section: Discussionmentioning

confidence: 99%

Feo-hifomicose causada por Veronaea bothryosa: relato de dois casos

Filho

Schwartz

Rehn

et al. 2005

An. Bras. Dermatol.

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Phaeohyphomycosis caused by Veronaea bothryosa is very rare. We report two cases. To our knowledge, these are the first and second cases to be reported on the American continent, and fourth and fifth cases in the world literature. We report one case in a kidney transplant recipient, and another case in an immunosuppressed non-transplant patient. Both patients presented with a lesion on the dorsal aspect of the foot, following trauma. One patient responded moderately well to treatment with itraconazole.

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Cutaneous Phaeohyphomycosis Caused by Veronaea bothryosa in a Liver Transplant Recipient Successfully Treated with Itraconazole

Cited by 32 publications

References 0 publications

Subcutaneous Phaeohyphomycosis Caused byVeronaeabotryosain the People’s Republic of China

Subcutaneous Phaeohyphomycosis Caused byVeronaeabotryosain the People’s Republic of China

Melanized Fungi in Human Disease

Feo-hifomicose causada por Veronaea bothryosa: relato de dois casos

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