Subcutaneous Phaeohyphomycosis Caused byVeronaeabotryosain the People’s Republic of China

Abstract

The second case of phaeohyphomycosis caused by Veronaea botryosa in China, in a 12-year-old boy from Jiangsu Province, is presented. Based on direct examination of the scrapings from crusted lesions; histologic examination of the biopsy tissue showing septate, phaeoid hyphal elements; and the culture exhibiting sympodial, conidiogenous cells producing predominantly two-celled, cylindric conidia, the etiologic agent was identified as V. botryosa. CASE REPORTA 12-year-old boy from Jiangsu Province, China, received a seemingly innocuous scratch on his right elbow at the age of 6 years. Later, several 10-to 12-by 6-to 8-mm papules with exudates appeared sporadically on his extremities and became crusted. Within a period of 2 years, the infection had spread to other parts of the body-namely, face, hands, legs, scrotum, and buttocks-except for the chest and back (Fig. 1). The lesions became nodular, forming thick, crusted areas, especially on the patient's face, the backs of his hands, and the crural area. Adjacent lesions often coalesced to form plaques. Superficial lymph node swellings were not observed. The peripheral blood was found to be normal with positive HbsAg. No abnormal findings were noted in a urine test, chest X ray, and abdominal echo examination. Histopathologic and mycological examinations were out and the patient received treatment, including antifungal therapy, over a period of many months, without significant improvement. Effective treatment is still being sought.Histopathologic examination. Biopsy tissue slides were stained by the hematoxylin and eosin stain and periodic acid Schiff's reagent procedures. Microscopic examination of hematoxylin-and eosin-stained slides revealed hyperkeratosis and incrustation accompanying parakeratosis and containing neutrophils and yellow-brown-pigmented, septate hyphal elements of various lengths. The epidermis was thickened irregularly and showed pseudoepitheliomatous hyperplasia. High-density inflammatory cells were seen in the upper and middle layers of the dermis. Microabscesses, composed of neutrophil aggregates surrounding hyphal elements, were present, and a granulomatous reaction consisting of giant cells containing fungal hyphae was observed. The hyphal elements of various lengths were septate, branched, or unbranched and were pale brown (Fig. 2).Mycological examination. Microscopic examination of the scrapings from crust of the lesions in potassium hydroxide mounts showed numerous septate, branched, yellowish-brownpigmented hyphae 2.5 to 4.0 m in diameter. Scrapings from the crusty lesions and biopsy tissue were cultured on in-houseprepared nutritional media (3), namely, Sabouraud dextrose agar containing chloramphenicol (SabϩC) and SabϩC containing cycloheximide. The culture plates were incubated at 25 and 37°C in the dark and were observed every 2 days. Numerous velvety, olivaceous gray colonies were observed after 7 to 10 days of incubation on all plates. Bacterial and mycobacterial cultures were negative.A subculture of the isolate was studied in gre...

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