Two Cases of Subcutaneous Infection Due to Phaeoacremonium spp

Abstract

We describe two cases in Brazil of human subcutaneous infections due to Phaeoacremonium spp. The first case was caused by Phaeoacremonium aleophilum. The patient presented with a unique fistulized nodule on the left ankle. The fungus was detected by direct microscopic examination and was isolated repeatedly from material collected from the lesion. This is the first reported case of human infection caused by this fungus. The second case was caused by Phaeoacremonium rubrigenum. The patient presented with multiple nodules around the left ankle and foot. The fungus was detected by direct examination of pus and histological sections of the nodules. It was repeatedly isolated from the clinical specimens. This is the second reported case of human infection caused by this species. CASE REPORTS Case 1. The patient was a 19-year-old male Brazilian clerk residing in the interior of the Rio Grande do Sul State, Brazil. He reported the presence of a painful nodule on the surface of his left ankle but had no history of recent injury in the affected area. The nodule was excised on six occasions, but it was not studied histologically or microbiologically. On examination in June 2001, a mycological study of the pus collected from a fistula close to the nodule was performed (Fig. 1A). The patient was otherwise in good physical condition and had no remarkable past medical history. Routine laboratory examination showed no abnormal findings. A direct microscopic examination of a potassium hydroxide preparation of the collected material was negative. However, cultures on Sabouraud dextrose agar (Oxoid, Basingstoke, England) at 35 to 37°C were positive. After 5 days of incubation, numerous whitish colonies with the same morphology were present. The fungus was tentatively identified as an Acremonium sp. Two more samples of pus were collected a week apart, and the same fungus grew again. Direct examination of the last collected material showed the presence of a few hyaline, septate hyphae (Fig. 1B). An X ray of the affected region demonstrated no bone or joint involvement. The nodule was surgically removed, and the patient received itraconazole (100 mg/day) for 2 months. The patient was then considered cured. Only two healed spots were present in the areas previously occupied by the nodules and the fistula.Case 2. The patient was a 55-year-old Brazilian white male residing in the interior of the Rio Grande do Sul State. He reported nonpainful multiple nodules on his left ankle and foot, with spontaneous drainage of pus. The nodules had appeared 8 months earlier. The patient self-administered ampicillin, cephalexin, and ciprofloxacin, though without medical prescription, but his condition did not improve. There was no recent history of injury to the ankle. Past medical history revealed that he had suffered from hypertension. Eight years before the case study, he had received a renal transplant, for which he had been placed on immunosuppressive therapy with cyclosporine (100 mg/day), prednisone (15 mg/day) and azathioprine (150 mg/day). ...

Phaeohyphomycosis: a clinical-epidemiological and diagnostic study of eighteen cases in Rio Grande do Sul, Brazil

“…Reviewing the relevant literature in RS, we found cases of phaeohyphomycosis (including cases 1, 2, 10 and 15 of the current series, which have been previously published) as follows: peritoneal, one case caused by Curvularia lunata (Lopes et al 1994), cutaneous, one case caused by C. lunata (Lopes & Jobim 1998), subcutaneous, 10 cases, including two cases with only his- topathological diagnoses available (Severo et al 1987), one case caused by E. jeanselmei, one case caused by Phaeoacremonium aleophilum and one caused by Phaeoacremonium rubrigenum (Guarro et al 2003), and systemic, one case caused by Cladophialophora bantiana (Walz et al 1997). Re-evaluation of morphological characteristics, supported by phylogenetic analysis, identified P. aleophilum as a new fungal species, Phaeoacremonium alvesti (Mostert et al 2005).…”

Species of Phaeoacremonium Associated with Infections in Humans and Environmental Reservoirs in Infected Woody Plants

“…(Calosphaeriales) (19). In addition to the three species listed above associated with human infections, P. aleophilum W. Gams, Crous, M.J. Wingf & L. Mugnai has recently been reported from a human subcutaneous infection (10), but the isolate involved is shown to be a member of a species described here as new.…”

“…CBS 729.97 could grow at 37°C, whereas isolates of P. inflatipes have a maximum growth temperature of 35°C. Another isolate of P. alvesii, CBS 110034, was reported from a subcutaneous infection as P. aleophilum (10). It produced yellow rather than red diffusing pigment on several media; thus, its close relatedness to the red-pigmented P. rubrigenum could not be phenotypically recognized.…”

“…Most reported Phaeoacremonium cases have involved subcutaneous abscesses, cysts, or chronic or acute osteoarthritis in immunocompetent or immunocompromised patients; these cases were often initiated by traumatic inoculation (22). Infections not preceded by injury have also been reported (10). In a few cases involving immunocompromised patients, disseminated infections, fungemia, or endocarditis have been found (22).…”

Phaeoacremonium krajdenii , a Cause of White Grain Eumycetoma

“…The majority of described human Phaeoacremonium infections have been subcutaneous abscesses and cysts or chronic or acute mycotic arthritis (6,8,12,15). Cases are reported with approximately equal frequencies in immunocompromised and immunocompetent hosts.…”