Phaeohyphomycosis of the eye caused by Exserohilum rostratum in India

Abstract

Summary. A 40‐year‐old woman developed a corneal ulcer with hypopyon following a traumatic episode. In a KOH mount dematiaceous, septate, branched hyphae were demonstrated, and heavy growth of Exserohilum rostratum was obtained in culture. No bacterial pathogens were isolated. The patient was treated with natamycin and subsequently with ketoconazole. In spite of antimycotic therapy a descemetocele of the eye remained. This observation represents the first documented case of an Exserohilum infection in India. Zusammenfassung. Eine 40‐jährige Frau entwickelte nach Trauma ein Hornhautulkus mit Hypopyon. Die Untersuchung von Hornhautab‐schabsel ergab mikroskopisch im KOH‐Präparat das Vorhandensein von verzweigten, septierten, pigmentierten Hyphen; in Kultur konnte Exserohilum rostratum gezüchtet werden. Bakterielle Erreger waren nicht nachweisbar. Die Patientin wurde zunächst mit Natamycin, später mit Ketoconazol behandelt. Trotz dieser antimykotischen Therapie verblieb eine Descemetozele des Auges. Dies ist der erste dokumentierte Fall einer Exsero‐hilum‐Infektion in Indien.

ESCMID and ECMM joint clinical guidelines for the diagnosis and management of systemic phaeohyphomycosis: diseases caused by black fungi

“…Exserohilum is a rare clinically significant pathogen causing invasive infections mainly in immunocompromised patients , keratitis or localized infections in immunocompetent individuals usually after accidental inoculation . The risk factors for Exserohilum infections include aplastic anaemia and haematopoietic stem cell transplantation .…”

A case of subcutaneous phaeohyphomycosis caused by Exserohilum species in an immunocompromised patient

“…Corneal infections are due to contamination of traumatic corneal abrasions with asexual fungal spores [3]. A rare case of corneal phaeohyphomycosis due to Exserohilum rostratum following organic trauma was reported from Department of Microbiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India in April 1996 [7]. Reports of four cases with two types of skin infection, cutaneous and subcutaneous caused by Exserohilum rostratum in immunocompromised men were published by the Department of Dermatology of the National Cheng-Kung University Hospital, Tainan, Taiwan in 1993 [8].…”

“…The pathogen is usually an environmental contaminant. Cases of nosocomial fungal infections linked to contaminated care material, especially cloth tape, adhesive tapes or wooden devices were reported in the literature [7]. It is recommended that when Bipolaris or Exserohilum species are isolated from clinical specimens, such isolates should not be carried out simply as contaminants; appropriate studies should be carried out to determine if they play an etiologic role [4].…”

Ethmoidal sinusitis caused by Exserohilum rostratum in a patient with malignant lymphoma after non‐myeloablative allogeneic peripheral blood stem cell transplantation

“…The literature indicates that Exserohilum causes localized infections involving the brain (15), nasal sinuses (16), eyes (17), and skin (18), as well as disseminated systemic infections among immunocompromised hosts (19). We believe that this report is the first description of E. rostratum sinus infection in a patient undergoing non‐myeloablative allogeneic PBSCT.…”