Ann Dermatol.  2019 Oct;31(5):571-575. 10.5021/ad.2019.31.5.571.

A Case of Subcutaneous and Intranasal Phaeohyphomycosis Caused by Microsphaeropsis arundinis in an Immunocompromised Patient Misdiagnosed with Mucormycosis

Affiliations
  • 1Department of Dermatology, School of Medicine, Chosun University, Gwangju, Korea. chna@chosun.ac.kr

Abstract

Microsphaeropsis arundinis is a dematiaceous fungus capable of causing soft tissue infections known as phaeohyphomycosis, mostly in immunocompromised individuals. These infections arise from the traumatic inoculation of fungal materials into the subcutis, and can spread to adjacent subcutaneous tissues or via the lymphatics in a sporotrichoid manner. A 76-year-old man presented with diffuse erythematous plaques and swelling on both forearms and dorsal hands, and rhinalgia. He had been undergoing treatment for hypertension, angina pectoris, and diabetes. Histopathologic examinations of the skin, painful nasal septum, and molecular identification using internal transcribed spacer regions confirmed a diagnosis of subcutaneous and intranasal phaeohyphomycosis caused by M. arundinis. The patient was treated with oral itraconazole for over 5 months, and no recurrence was observed until the time of writing this manuscript. We report a rare case of subcutaneous and intranasal phaeohyphomycosis caused by M. arundinis and propose that confirmation of the causative strains is necessary, as it could affect the prognosis and treatment of the disease.

Keyword

Fungal infection; Microsphaeropsis arundinis; Phaeohyphomycosis

MeSH Terms

Aged
Angina Pectoris
Diagnosis
Forearm
Fungi
Hand
Humans
Hypertension
Immunocompromised Host*
Itraconazole
Mucormycosis*
Nasal Septum
Phaeohyphomycosis*
Prognosis
Recurrence
Skin
Soft Tissue Infections
Subcutaneous Tissue
Writing
Itraconazole

Figure

  • Fig. 1 (A) Diffuse purulent erythematous plaques and swelling with scales and pustules on both dorsal hands and forearms of the patient; (B) necrotic changes in the nasal septum with hemorrhage and exudate; (C) and completely recovered lesions after treatment with itraconazole for 5 months.

  • Fig. 2 (A, B) Dense infiltrates of inflammatory cells such as neutrophils, monocytes, histiocytes, and giant cells extending from the upper dermis through the subcutaneous fatty layer (H&E: A, ×40; B, ×200); (C, D) Gomori's methenamine silver (GMS) staining and periodic acid-Schiff (PAS) staining revealed fungal hyphae and spores (C: GMS, ×400, D: PAS, ×400).

  • Fig. 3 (A) Microsphaeropsis arundinis colonies growing on Sabouraud dextrose agar at 30℃ demonstrating gray to dark green colonies (14 days); (B) microscopic morphology of M. arundinis stained with lactophenol cotton blue showing pigmented, septate, and irregularly formed hyphae, with swollen segments.

  • Fig. 4 The sequence of the D1/D2 domain of ribosomal RNA gene regions and ITS1-5.8S-ITS2 regions showed identity with Microsphaeropsis arundinis (100% sequence identity to M. arundinis CBS 100243 [GenBank accession number JX 496123.1] and 100% sequence identity to M. arundinis 0012 [GenBank accession number KY992587.1]).


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