Isolated endogenous endophthalmitis due to a sporodochial-formingPhialemonium curvatumacquired through intracavernous autoinjections

Abstract

We report a case of endogenous endophthalmitis due to a sporodochial-forming species of Phialemonium curvatum. The infection led to the enucleation of the affected eye, but there was no evidence of systemic dissemination. The isolated P. curvatum produced aggregates of phialides, many occurring on coils or in verticils, which eventually develop into sporodochia. The initial and post-enucleation isolates revealed they were identical to strains of P. curvatum from Israel causing disseminated disease in patients practicing intracavernous autoinjections for the treatment of erectile dysfunction. The reported case had unusual clinical and microbiological features. Despite the route of acquisition and the lack of systemic antifungal therapy, the infection did not spread beyond the eye. The morphology of the phialides aggregates was also unique, and the distinction between Volutella and Acremonium is discussed. This case expands the spectrum of infections due to Phialemonium species, and reveals a novel way of developing fungal endophthalmitis.

Molecular and Phenotypic Characterization of Phialemonium and Lecythophora Isolates from Clinical Samples

“…Other authors had already reported the presence of these structures (19,24,26,32). Some isolates of Phialemonium (Phialemonium sp.…”

Phialemonium obovatumKeratitis after Penetration Injury of the Cornea

“…In light microscopy, the conidial shape has an obovate form [1,9]. In the past 20 years, 16 cases of Phialemonium genus-induced infections have been reported and three of these infections were intraocular P. curvatum infections [1-5]. No ocular P. obovatum infections have been reported.…”

“…The fungus is isolated from soil, air, water, or sewage. In very rare cases, it has been reported to be a cause of invasive disease [1-5]. We experienced a case in which keratitis developed during the monitoring of the clinical course after the primary closure of corneal laceration.…”

Subcutaneous Phaeohyphomycotic Nodule Due to Phialemoniopsis hongkongensis sp. nov

“…Although Phialemoniopsis species grow as pale colonies, melanin has been detected in their hyphae, and therefore, infections due to these dematiaceous molds are considered to be phaeohyphomycosis (6). Phialemoniopsis species have been reported to cause endocarditis and endovascular infections (9,17,20,22), endophthalmitis and keratitis (2,15,16,18,19), fungemia (7,12,24), meningitis (21), septic arthritis and spondylodiscitis (10,23), and skin and soft tissue infections (1,6,8,25) in humans, with some cases being fatal infections. In addition, they have been isolated from various clinical specimens, including those from cerebrospinal fluid, corneal and vitreous fluid, peritoneal dialysis catheter, sinus, skin lesions and nails, and synovial fluid, although the clinical details of the patients were not presented (1,2,13).…”

“…Members of this genus are widely distributed in the environment, having been isolated from air, industrial water (2), plant materials (3)(4)(5), river water, sewage, and soil (2), making these fungi emerging opportunists for causing human infections. Phialemoniopsis species have been detected in different continents, including Africa (4), the Americas (1-3, 6-16), Antarctica (2), Asia (5,(17)(18)(19)(20)(21), and Europe (2,(22)(23)(24)(25). Although Phialemoniopsis species grow as pale colonies, melanin has been detected in their hyphae, and therefore, infections due to these dematiaceous molds are considered to be phaeohyphomycosis (6).…”