The first case of cutaneous phaeohyphomycosis caused by Bipolaris spicifera in Northern China: A case report

Abstract

Abstract. Phaeohyphomycosis (PHM) is a term used to describe any fungus presenting in tissues with pseudohyphae, hyphae, brown yeast-like cells or a combination of these forms. Sinusitis and skin infections are the most common presentation of subcutaneous PHM caused by the fungus Bipolaris spicifera. However, the majority of cases have so far been encountered in tropical climatic zones. The present study documents a case of subcutaneous PHM caused by infection with Bipolaris spicifera in a 56-year-old Chinese man, who presented with plaque papillomatosis on the left foot. The organism isolated from the lesion scar and tissue was identified as Bipolaris spicifera by its morphology, histopathology and DNA sequencing. The patient was successfully treated with itraconazole and terbinafine. IntroductionPhaeohyphomycosis (PHM) refers to phaeoid fungal infections with specific structures including pseudohyphae, hyphae and brown yeast-like cells seen in tissue samples (1,2). Currently, there are at least 60 genera and 109 species that can cause PHM. The most frequent etiologic agents are Exophiala spinifera, Wa ngiella spinifera, Phialophora spinifera a nd Bipolaris spinifera (3).PHM-inducing agents are widely distributed around the world; however, they are more frequently observed in tropical and subtropical climates (4). PHM occurs in immunocompromised and immunocompetent individuals, although organ transplantation, cancer, leukemia, prolonged hospitalization and corticosteroid therapy are predisposing factors (5,6). Cases of PHM have been reported in different regions such as the Caribbean islands, parts of South America, Africa, the Indian subcontinent, Southeast Asia, and the West Pacific Islands (3). The incidence in patients with solid organ transplantation is ~9% (5).PHM may be categorized as either superficial, cutaneous and corneal, subcutaneous, and systemic PHM (5). Bipolaris spicifera is typically associated with subcutaneous PHM and symptoms such as sinusitis and skin infections (7,8). The majority of cases so far have been encountered in tropical climatic zones (5). The present case, however, exhibits the first case of subcutaneous phaeohyphomycosis caused by Bipolaris spicifera in Northern China, in an area with a subtropical climate. Case reportA 56-year-old Chinese male presenting with papular nodules and plaque papillomatosis on the left foot was admitted into the Department of Dermatology, Qingdao University Affiliated Hospital (Qingdao, China) in June 2014. Initial onset was characterized by the appearance of scattered papules and nodules on the dorsum of the left foot 10 years previously, without clinical symptoms. The lesion converged gradually, formed a granuloma-like lesion and spread from the hallux to the dorsum of the foot and the second, third and fourth toes, with occasional co-presentation of bloody pus. The patient also had a prior medical history of rheumatoid arthritis for one year prior to this onset. The patient was a farmer living in Shandong Province, had never traveled outside the ...

Unwanted Diagnosis of a Subcutaneous Swelling

“…Any fungus in tissue with pseudohyphae, hyphae, brown yeast-like cells, or a combination of these forms is well described under term phaeohyphomycosis (PHM) [1]. It is a relatively new term introduced by Ajello in 1974 [2].…”