Subcutaneous phaeohyphomycosis due to Cladophialophora bantiana: a first case report in an immunocompetent patient in Latin America and a brief literature review

Abstract

We report a rare case of subcutaneous phaeohyphomycosis caused by Cladophialophora bantiana in an immunocompetent patient in Amazonas, Brazil. This dematiaceous fungus has been mainly associated with life-threatening infections affecting the central nervous systems of immunosuppressed patients. We present the clinical, laboratory, and therapeutic aspects, and in vitro susceptibility test results for different antifungal drugs. A brief review of the cases reported in the literature over the past 20 years has also been discussed. According to the literature review, the present case is the first report of subcutaneous phaeohyphomycosis due to C. bantiana in an immunocompetent patient in Latin America.

Phaeohyphomycosis: A Review

“…dimidiatum shows a dark grey villous mold [24]. C. bantiana develops in seven days folded, velvety, dark or gray-greenish colonies, and a black reverse [4,35]. C. cassiicola shows numerous velvety gray colonies with short aerial mycelia [10].…”

“…Microscopically, N. dimidiatum has dark brown septate hyphae and ellipsoidal or oval-shaped chains of unicellular or bicellular arthroconidia [24]. C. bantiana has a long cladosporium-like reproduction with elongated brown and septate conidiophores, and single-celled conidia in long chains; the spores are pigmented, spherical or elliptical, and measure 2 µm to 2.5 µm by 4 µm to 7 µm [4,35]. P. crystallina is observed as septate hyphae without sporulation [14].…”

“…The treatments reported for cases caused by C. bantiana, mainly in cerebrospinal infections, are amphotericin B (0.7 to 1.0 mg/kg/daily), ketaconazole always in combination with flucytosine (150 mg/kg/daily), fluconazole (200 to 400 mg/daily), itraconazole (200 to 600 mg/daily); voriconazole (dose of 4 mg/kg/daily and subsequently two loading doses of 6 mg/kg/daily and subsequently 4 mg/kg/daily), posaconazole, and caspofungin (0.7 mg/kg/daily) have been administered in several relatively recent cases [12,35].…”