Multiple subcutaneous cysts due toExophiala spiniferain an immunocompetent patient

Abstract

Here we report a case of a 55-year-old Indian male presenting with multiple subcutaneous cysts, which developed from painful nodules at the dorsal right wrist joint. Subsequently a painful nodule appeared on the left knee joint. Cytological examination of the knee swelling revealed a suppurative inflammatory lesion consisting of neutrophils, lymphocytes, multinucleated giant cells and few fungal elements, without involvement of the overlying skin. Exophiala spinifera was cultured (CBS 125607) and its identity was confirmed by sequencing of the internal transcribed spacer (ITS rDNA). The cysts were excised surgically, without need of additional antifungal therapy. There was no relapse during one-year follow-up and the patient was cured successfully. In vitro antifungal susceptibility testing showed that posaconazole (0.063 μg/ml) and itraconazole (0.125 μg/ml) had the highest and caspofungin (4 μg/ml) and anidulafungin (2 μg/ml) the lowest activity against this isolate. However, their clinical effectiveness in the treatment of E. spinifera infections remains to be evaluated. In this case report, we have also compiled cases of human E. spinifera mycoses which have been reported so far.

Comparative Ecology of Capsular Exophiala Species Causing Disseminated Infection in Humans

“…Some cases (Rajam et al, 1958 ; Barba-Gomez et al, 1992 ; Padhye et al, 1996 ; Develoux et al, 2006 ; Tomson et al, 2006 ; Srinivas et al, 2016 ) were reported as chromoblastomycosis, although typical muriform cells were mostly lacking. Fatal systemic infections are known; 36 cases have been recorded in English and Chinese literature (Rajam et al, 1958 ; Nishimura and Miyaji, 1983 ; Padhye et al, 1983 , 1984 ; Mirza et al, 1993 ; Campos-Takaki and Jardim, 1994 ; de Hoog et al, 1999 ; Rajendran et al, 2003 ; Negroni et al, 2004 ; Dutriaux et al, 2005 ; Baubion et al, 2008 ; Singal et al, 2008 ; Fothergill et al, 2009 ; Harris et al, 2009 ; Radhakrishnan et al, 2010 ; Li et al, 2011 ; Badali et al, 2012 ; Daboit et al, 2012 ; Lin et al, 2012 ; Bohelay et al, 2016 ; Silva et al, 2017 ; Table 2 ). Among the 12 systemic infections, all cases concerned immunocompetent patients.…”

“…Phenotypic intraspecific variation was found e.g., in protease, urease and acid production, but none of these parameters could be linked (Table 3 ). Antifungal susceptibility shows some variability in both species (Badali et al, 2012 ), and this could not be linked to other types of variation either. Given the rather significant variation in susceptibility, it is recommended always to perform in vitro prior to therapy.…”

Phaeohyphomycosis: Cytomorphologic Evaluation in Eleven Cases

“…Subcutaneous swellings in phaeohyphomycosis are easily amenable to fine needle aspiration cytology, which serves as a rapid diagnostic tool enabling the timely administration of antifungal agents. A literature search showed a relative paucity of publications, largely limited to case reports on the cytomorphology of phaeohyphomycosis [4-6]. The present study was undertaken to establish the role of cytology in diagnosing phaeohyphomycosis and to further discuss potential diagnostic pitfalls and differential diagnoses.…”

A molecular approach for the rapid, selective and sensitive detection of Exophiala jeanselmei in environmental samples: development and performance assessment of a real-time PCR assay

“…Nevertheless, although limited data on the number of cases occurring are available and the epidemiology of airways infections caused by E. jeanselmei is poorly documented. Inside buildings, the way of contamination by this species is presumably linked to water reservoirs of air-conditioning units or pipings (Badali et al 2012 ; Wang et al 2001 ). As this species can cause health problems, its monitoring is needed.…”

“…For E. jeanselmei , these ITS regions offer the possibility to develop molecular tools to discriminate the species, even inside the E. spinifera clade (Wang et al 2001 ; Woo et al 2013a ; Zeng and De Hoog 2008 ). Despite these previous studies investigating the E. jeanselmei genotype (Badali et al 2012 ; Kawasaki et al 2005 , 1999; Woo et al 2013a ), molecular tools for the specific detection of this fungus are however still poorly documented.…”