Subcutaneous phaeohyphomycosis caused byLasiodiplodia theobromaeand successfully treated surgically

Abstract

While visiting Jamaica, a 50-year-old woman stumbled on an outdoor wooden staircase and sustained an injury to the right leg. The wound was cleaned topically and the patient was given antibacterial therapy. Five weeks later, in Canada, she presented with an ulcer at the injury site. An excisional biopsy showed copious broad, septate, melanized fungal filaments penetrating into tissue. Culture yielded a nonsporulating melanized mycelium. The isolate was strongly inhibited by cycloheximide and benomyl but grew at 37 degrees C. After 16 weeks cultivation on modified Leonian's agar at 25 degrees C, it developed pycnidia characteristic of Lasiodiplodia theobromae, a common tropical phytopathogen mainly known previously as a rare agent of keratitis and onychomycosis in humans. The patient was not given antifungal chemotherapy, and the ulcer, which had been broadly excised in the biopsy procedure, ultimately resolved after treatment with saline compresses. The six-month follow-up showed no sign of infection. This case, interpreted in light of previously reported cases, shows that on rare occasions L. theobromae is able to act as an agent of subcutaneous phaeohyphomycosis and that, when this occurs, debridement alone may be sufficient to eradicate it.

Molecular and Matrix-Assisted Laser Desorption Ionization–Time of Flight Mass Spectrometry-Based Characterization of Clinically Significant Melanized Fungi in India

“…Also, in the present study the first case of keratitis due to R. percutanea was observed. Further, L. parva, which had not been previously reported from human infections, was found to be the etiologic agent of postoperative wound infection in a renal transplant patient, although other species, such as L. theobromae, detected as agents of keratitis in this study, have previously been documented as agents of keratitis and subcutaneous infections (22)(23)(24)(25). Interestingly, fungal osteomyelitis of the foot due to C. bantiana and Corynespora spp.…”

Melanized Fungi in Human Disease

“…Terbinafine has also been used successfully, particularly in patients failing azole therapy (7). Surgical excision alone has been successful in a number of cases, even in organ transplant patients (12,194,235,387,418,558,587,646,686,720,764). The Mohs surgical technique, which was developed for removing melanoma, may be a useful surgical approach, as it spares tissue and completely removes the pathological lesion in staged surgeries (86).…”

“…and Phialophora spp. are the next most common fungi, followed by Cladosporium spp., Exserohilum spp., Veronaea botryosa, and many others with scattered case reports (7,12,19,23,32,36,56,61,65,81,140,143,194,209,230,241,251,258,306,313,342,362,365,369,387,413,418,421,457,469,482,486,487,495,539,559,556,568,571,576,590,609,613,614,646,659,694,699,720,728,…”

An unusual skin lesion caused by lasiodiplodia theobromae

“…Human infections are rare, but there are case reports involving both immunocompetent and immunosuppressed patients. To our knowledge, there have been 3 previous cases reported in the literature of subcutaneous infections [5][6][7]. These cases were managed with surgical debridement and did not require specific antifungal therapy.…”

“…The fungus grew rapidly from cultures of a lesion on the foot of an active male, who had previously experienced a penetrating marine water injury. To our knowledge, there have been 3 previous cases reported in the literature of subcutaneous infections [5][6][7]. Whilst the fungus grows rapidly on routine media, sporulation was difficult and time consuming toachieve and DNA sequencing may be a quicker method.…”