Deep Skin Infection of Scedosporium apiospermum in a Patient with Refractory Idiopathic Thrombocytopenic Purpura

Abstract

Infection of Scedosporium apiospermum is very rare but is now emerging as an important cause of both localized and disseminated infections in immunocompromised patients. A 62-year-old woman, who had undergone steroid therapy for refractory idiopathic thrombocytopenic purpura and had a history of diffuse large B cell lymphoma, developed a deep skin ulcer complicated with lymphangitis. After culture study demonstrated the presence of S. apiospermum, voriconazole (VRCZ) was administered and prompt improvement was observed. Because it is difficult to distinguish S. apiospermum from Aspergillus by histopathology and S. apiospermum is resistant to amphotericin B, VRCZ should be selected as the first choice of antifungal agent when mold is considered to be the causative organism.

Histopathological clues in the diagnosis of fungal infection by Scedosporium in a case of endophthalmitis starting as conjunctivitis

“…Invasive infections are seen mainly after traumatisms in joints, the skin, or the cornea, followed by penetration of the fungus and ‘grains’ of colonies that reject treatment. The final result is persistent arthritis, keratitis, osteomyelitis or subcutaneous infections . The last condition is usually seen in immunosuppressed patients, in whom the clinical presentation can be more complicated through the development of invasive sinusitis, pneumonia, arthritis with osteomyelitis, cutaneous and subcutaneous granulomata or disseminated systemic disease, with a tendency to disseminate to the central nervous system with meningitis or brain abscesses .…”

“…The last condition is usually seen in immunosuppressed patients, in whom the clinical presentation can be more complicated through the development of invasive sinusitis, pneumonia, arthritis with osteomyelitis, cutaneous and subcutaneous granulomata or disseminated systemic disease, with a tendency to disseminate to the central nervous system with meningitis or brain abscesses . Most cases of endophthalmitis by Scedosporium have been described in the context of immunosuppression . Endophthalmitis sometimes follows a traumatism, although endogenous cases are not uncommon .…”

“…Some of them have been described in immunocompetent individuals . Typical characteristic hyphae are shown in the figures presented in some of the reports of cutaneous cases . Some of the articles just mention the ‘45°‐’ or the ‘acute angle‐’ branching patterns of the fungus.…”