Pheomycotic cyst in an immunosuppressed host

Fathizadeh, Ahmad; Rippon, John W.; Rosenfeld, Stewart I.; Fretzin, David F.; Lorincz, Allan L.

doi:10.1016/s0190-9622(81)80003-5

Cited by 8 publications

(2 citation statements)

References 6 publications

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“…The lesional surfaces may become ulcerated, develop pustules, crusts, and verrucose areas, or even mycetomatoid presentation 2,5 . Generally, there is no tendency towards lymphatic spread, and dissemination is very rare unless complicated by immunosuppression, steroid therapy, and/or diabetes, as seen in our case 6 . Dissemination can lead to endophthalmitis, endocarditis, peritonitis, various pulmonary presentations, osteomyelitis, brain involvement, and other invasive conditions 2 .…”

Section: Discussionmentioning

confidence: 67%

Disseminated pheohyphomycosis

Shivaswamy¹,

Pradhan²,

Chandrashekar³

et al. 2007

Int J Dermatology

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A 40-year-old male agricultural laborer presented to our clinic with asymptomatic swellings on his left hand and left leg of 2 years' duration. A pea-sized swelling was first noticed on the back of the left hand, which was gradual in onset and slowly progressed to its present size. The patient later noticed multiple swellings over his left leg and thigh, with a similar progression. There was no history suggestive of inflammatory changes or discharge from the lesions. There was no previous history of trauma. The patient was an asthmatic and was on long-term oral steroid therapy (10-20 mg/day prednisolone). None of his family members had similar complaints. On physical examination, the patient was febrile. Cutaneous examination showed multiple, circumscribed, lobulated, non-tender, mobile, cystic swellings of various sizes, ranging from less than 2 cm over the left shin to more than 8 cm over the dorsum of the left hand and ankle (Fig. 1a,b). The surface over these swellings was shiny, smooth, and intact. The skin over the swellings was pliable and normal in color. There was no regional lymphadenopathy. The rest of the clinical examination was normal, except for decreased breath sounds over the left mid and lower pulmonary lobes. Routine laboratory tests, including complete blood count and liver and renal function tests, were within normal limits. Random blood glucose was greater than 400 mg%. Histopathologic examination of one of the cysts (from the hand) showed pheohyphomycotic cysts lined by dense fibrous tissue with chronic inflammatory infiltrate admixed with scattered giant cells in the dermis (Fig. 2). No fungal elements were visualized in the hematoxylin and eosin-stained sections. The fungal elements were found within the cystic cavity on special staining with Gomori's methenamine silver (GMS) and Masson-Fontana stains. The hyphae had irregularly placed branches and showed constrictions around their septae, thus resembling pseudohyphae and yeast forms (Fig. 3). Fine needle aspiration cytology from one of the swellings showed the presence of filamentous fungi on KOH examination and brown-pigmented distorted filaments and yeast-like cells on Masson-Fontana staining (Fig. 4a,b). The positive Masson-Fontana stain was indicative of the presence of melanin in the fungal hyphae, even when the fungal hyphae were not pigmented in the hematoxylin and eosin-stained section. Periodic acid-Schiff reagent also stained the fungal elements, thus confirming our diagnosis of pheohyphomycosis and ruling out the possibility of hyalohyphomycosis. The culture for fungus from the swelling aspirate grew contaminants. The chest X-ray showed dense nodular shadows in the left lower and mid pulmonary lobes. Sputum for acid-fast bacilli and Mantoux test were negative. During the hospital stay, the patient developed high fever and showed altered behavior, for which a computed tomography scan of the brain was performed; this showed evidence of multiple ring enhancing lesions in both frontal lobes. Ultrasound of the abdomen was normal. O...

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Section: Discussionmentioning

confidence: 67%

Disseminated pheohyphomycosis

Shivaswamy¹,

Pradhan²,

Chandrashekar³

et al. 2007

Int J Dermatology

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“…Primary cutaneous hyalohyphomycosis and phaeohyphomycosis have been reported to present clinically in many ways. These include asymptomatic nodules and cysts (2,13), verrucous plaques (5), multiple nodules (7), and crusted erythematous nodules studded with pustules (4). In healthy individuals, the most common presentation is that of a nontender, firm or fluctuant subcutaneous nodule (2).…”

Section: Discussionmentioning

confidence: 99%

Hyalohyphomycosis masquerading as squamous cell carcinoma

Griffin

McFarland

1991

J Cutan Pathol

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A case of primary cutaneous hyalohyphomycosis in a healthy individual is presented. The initial clinical impression was keratoacanthoma or squamous cell carcinoma. Upon excision, the lesion proved to be an example of cutaneous hyalohyphomycosis due to an unidentified, non-pigmented fungal organism. The lesion was completely excised, and the patient was treated with saturated solution of potassium iodide. To date, there has been no evidence of recurrence. The clinical, histologic and mycologic aspects of hyalophyphomycosis are discussed.

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Papules and Nodules in a Patient With Sarcoidosis

Perry¹

1987

Arch Dermatol

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A 63-year-old man was referred to the Gainesville (Fla) Veterans Administration Medical Center dermatology clinic with a six-month history of asymptomatic papules on his left arm and an enlarging tender nodule on his left leg. He had been referred by his pulmonary physician with a tentative diagnosis of cutaneous sarcoidosis.A diagnosis of systemic sarcoidosis was made one year earlier, when the patient had presented with fatigue, 15-kg weight loss, and hypercalcemia. A left hilar mass was found on chest roentgenogram, and the biopsy of this mass at mediastinoscopy revealed a lymph node with noncaseating granulomas, consistent with sarcoidosis. Special stains and cultures of the biopsy specimen were negative. Prednisone therapy (30 mg/d) was started, with prompt improvement in the patient's symptoms and resolution of the hypercalcemia. No skin lesions had been noted at the time of this initial workup.Five months prior to referral and one month prior to onset of the skin lesions, the patient was hospitalized with a perforated diverticulum and abscess formation, which responded to nonsurgical therapy. One month prior to referral, he was admitted with an upper gastrointestinal tract hemorrhage, and a pep¬ tic ulcer was diagnosed. The patient noted slight pruritus involving his left arm and leg but denied trauma prior to the onset of the skin lesions. At the time of referral, his medications included prednisone (30 mg every other day), allopurinol, nadolol and prazosin hydrochloride for hypertension, and ranitidine.Dermatologie examination was notable for the presence of four 1-cm firm, pink, slightly scaling papules on the upper left part of the patient's arm and forearm (Fig 1). There was a tender, 4 X 5-cm, erythematous, well-circumscribed nodule on the left popliteal fossa (Fig 2). Tinea pedis was also noted. The referring medical physician felt that the results of the remainder of the patient's physical examina¬ tion were unchanged.Biopsy specimens were obtained from the left arm (Figs 3 and 4) and the left leg lesions.

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Pheomycotic cyst in an immunosuppressed host

Cited by 8 publications

References 6 publications

Disseminated pheohyphomycosis

Disseminated pheohyphomycosis

Hyalohyphomycosis masquerading as squamous cell carcinoma

Papules and Nodules in a Patient With Sarcoidosis

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