Cutaneous protothecosis in a patient with previously undiagnosed HIV infection

Abstract

Protothecosis is an uncommon condition resulting from infection by achlorophyllous algae of the Prototheca species. Immunocompromised individuals are generally most susceptible to protothecal infection and tend to develop severe and disseminated disease. However, the association between protothecosis and HIV-induced immunosuppression is not clear, with only a handful of cases having been described to date. Here we report a case of cutaneous protothecosis in a Chinese man with previously undiagnosed HIV infection that responded well to oral itraconazole.

Cutaneous Protothecosis in a Patient with Chronic Lymphocytic Leukemia: A Case Report and Literature Review

“…Most protothecosis infections occur in patients with predisposing factors, such as human immunodeficiency/acquired immunodeficiency syndrome, diabetes mellitus, underlying malignancy, chemotherapy, radiotherapy, renal transplantation and prolonged systemic corticosteroid administration [ 20 , 21 , 22 ]. Of approximately ninety-four total reports of cutaneous protothecosis, the most common risk factors appear to be diabetes mellitus (21%) and chronic steroid use (24%) [ 6 , 9 , 23 , 24 , 25 , 26 , 27 ]. Malignancy is associated in only 9% of cases; however, the presence of multiple other risk factors in conjunction with neoplasia warrants the consideration of protothecosis in the differential diagnosis when puzzling non-specific skin lesions are detected.…”

Clinicopathological features and course of cutaneous protothecosis

“…Prototheca infection involves the skin, bursa and visceral organs . Prototheca infection is thought to result from traumatic inoculation . The cutaneous manifestations are diverse, ranging from localized to disseminated lesions such as papules or vesiculobullous blisters .…”

“…To date, there is only a very limited number of protothecosis cases reported as case reports or small case series. Protothecosis is considered to be associated with immunosuppression, diabetes mellitus, organ transplantation, acquired immunodeficiency syndrome and adrenal insufficiency . Decreased neutrophil count or impaired neutrophil function is assumed to be highly associated with protothecosis but remains controversial .…”

Cutaneous protothecosis on the bilateral wrists of a food handler

“…Cutaneous protothecosis is variable in presentation and mimics many conditions, such as atopic dermatitis and common fungal infections such as Candida . The typical presentation is an erythematous plaque, but can range from psoriasiform lesions over all limbs to (rarely) onychoprotothecosis . There is no established treatment, but antifungals such as amphotericin B and azoles, with or without adjuvant excision, have yielded success .…”

“…3 The typical presentation is an erythematous plaque, 3 but can range from psoriasiform lesions over all limbs to (rarely) onychoprotothecosis. 4,5 There is no established treatment, but antifungals such as amphotericin B and azoles, with or without adjuvant excision, have yielded success. 3 We report a case of cutaneous protothecosis in a food handler, initially treated unsuccessfully as eczema.…”