1/745. Cutaneous phaeohyphomycosis due to Cladophialophora bantiana. We present a case of cutaneous infection due to Cladophialophora bantiana, an agent of phaeohyphomycosis. The patient developed a nodule with pustule formation on the dorsum of the left hand; no trauma was reported. The lesion was successfully treated with itraconazole and surgical excision. Histopathologically, there was a blastomycosis-like tissue reaction pattern. Pigmented organisms were readily identified in tissue sections, and the cultural characteristics were those of Cladophialophora bantiana. This organism, known primarily for intracerebral involvement, can rarely produce cutaneous and subcutaneous infection. immunosuppression should be suspected but is not always clinically apparent, as was demonstrated by our case. ( info) |
| A forty-year-old man underwent an allogeneic BMT from his HLA identical sister. GvHD prophylaxis was done with cyclosporine (CyA), methotrexate and prednisone (PDN). On day 90 extensive GvHD was noted and higher doses of immunosuppressive drugs alternating CyA with PDN were initiated. Patient's follow-up was complicated by intermittent episodes of leukopenia and monthly episodes of sinusitis or pneumonia. One year after BMT, the patient developed hoarseness and nasal voice. No etiologic agent could be identified on a biopsy sample of the vocal chord. Upon tapering the doses of immunosuppressive drugs, the patient had worsening of chronic GvHD and was reintroduced on high doses of cyclosporine alternating with prednisone on day 550. Three months later, GvHD remained out of control and the patient was started on azathioprine. On day 700, hoarseness and nasal voice recurred. Another biopsy of the left vocal chord failed to demonstrate infection. Episodes of sinusitis became more frequent and azathioprine was withheld 3 months after it was started. One month later, the patient had bloody nasal discharge and surgical drainage of maxillary sinuses was performed. Histopathology showed hyphae and cultures grew scedosporium apiospermum. itraconazole 800 mg/day was initiated. The patient developed progressive respiratory failure and died 15 days later. ( info) |
3/745. Primary subcutaneous mucormycosis (zygomycosis): a case report. A case of mycormycosis presenting primarily as a subcutaneous mass of the left leg in an immunocompetent individual is described. The mass that was diagnosed initially as a non-specific foreign body granulomatous process recurred a year later. Histopathological examination of the primary and recurrent lesions revealed partly degenerated hyphae associated with acute necrotizing and chronic granulomatous inflammation. Histomorphological features of primary subcutaneous mucormycosis without predisposing factors have not been previously reported. ( info) |
4/745. Two cases of tinea pedis caused by Scytalidium hyalinum. Two cases of tinea pedis due to Scytalidium hyalinum, the first to be described in italy, are reported. The patients were a 41-year-old woman and a 35-year-old man who had spent periods in the Caribbean. The clinical manifestations were indistinguishable from those caused by dermatophytes. In the women they were striking with 'moccasin foot' type lesions, whereas in the man they were less evident, with minor plantar desquamation and interdigital maceration. Diagnosis was based on direct mycological microscopic examination and culture. Clinical and mycological remission were obtained with systemic itraconazole therapy. These cases are reported because infections caused by Scytalidium hyalinum are rare in europe and their clinical and mycological diagnosis, as well as therapy, may be problematic. ( info) |
5/745. Occurrence of dermatomycosis (ringworm) due to trichophyton verrucosum in dairy calves and its spread to animal attendants. Persistent dermatomycosis (ringworm) caused by trichophyton verrucosum affected 20 dairy calves aged between 3 months and 1 year and housed together. The infection also spread to 2 animal attendants working among the calves. The major clinical lesions observed on the affected calves were extensive alopecia and/or circumscribed thick hairless skin patches affecting the head, neck, flanks and limbs. The observed lesions persisted for more than 17 weeks and most of the calves did not respond to topical treatment with various anti-fungal drugs within the anticipated period of 9 weeks. Two animal attendants developed skin lesions that were circumscribed and itchy and there was good response to treatment following the application of anti-fungal skin ointment. Although ringworm in dairy animals in kenya has not previously been associated with spread to humans, the potential is evident from this report. ( info) |
6/745. A case of subcutaneous infection in a patient with discoid lupus erythematosus caused by a Scytalidium synanamorph of Nattrassia mangiferae, and its treatment. A case of subcutaneous infection caused by Scytalidium synanamorph of Nattrassia mangiferae is reported in a 24-year-old female suffering from subacute discoid lupus erythematosus. Lesions were seen on the palm of the left hand and dorsal aspect of the right hand. Histopathology of the biopsied specimen revealed light brown hyphae and single celled structures along with many inflammatory cells. The patient showed marked improvement with oral chloroquin and itraconazole orally and ketoconazole cream topically. ( info) |
| The patient, a 59-year-old male, had been diagnosed as having alcoholic hepatopathy 20 years previously. He noticed localized swelling on his left leg after fishing in a river. The patient was diagnosed as having cutaneous mucormycosis upon histological and mycological examination of the skin. Gradual improvement of the symptoms was noted four weeks after administration of itraconazole and fruconazole; these were discontinued after five months. ( info) |
8/745. Primary cutaneous cryptococcosis in an hiv-negative patient. We report a case of primary cutaneous cryptococcosis in an hiv-negative patient, who presented with painless, ulcerated lesions involving the right forearm (fingers and elbow), which developed over 45 days. On the basis of the clinical appearance, serological and cultural examinations were performed to confirm the diagnosis; the histological evaluation of a skin biopsy showed an acute inflammatory infiltrate containing several PAS Cryptococci. Subsequently, the patient was treated with fluconazole (400 mg/day for 10 days, then a maintenance therapy of 200 mg/day); after one month, the cutaneous lesions were remarkably improved, but, although a series of further laboratory and clinical examinations was scheduled, the patient repeatedly refused any other re-evaluation, and he was lost from follow-up. ( info) |
9/745. zygomycosis due to Apophysomyces elegans: report of 2 cases and review of the literature. OBJECTIVE: The zygomycete Apophysomyces elegans is an unusual human pathogen that is being reported with increasing frequency as a cause of infection in previously healthy patients following trauma or after invasive procedures. We report 2 cases of infection caused by this emerging fungal pathogen. methods: Histologic sections of tissue removed from the infected patients and the isolates in culture were examined. Other infections caused by A. elegans that have been reported in the literature were reviewed. RESULTS: Both patients developed infection due to A. elegans after sustaining trauma that required tissue debridement because of tissue necrosis. Histologic examination showed broad, sparsely septate, thin-walled hyphae and angioinvasion with thrombosis. Extensive coagulation necrosis of surrounding tissue was seen. A rapidly growing mold with sporangiophores having funnel-shaped apophyses and pyriform sporangia, characteristic of A. elegans, was isolated from each case. CONCLUSION: Apophysomyces elegans is an opportunistic pathogen that can cause infection in previously healthy patients who suffer an injury to the cutaneous barrier, such as trauma or burns. infection with this zygomycete should be considered when there is progressive necrosis of a wound in a previously healthy patient. Successful treatment requires tissue debridement and amphotericin b. Histologic examination for early diagnosis and frozen section evaluation of surgical margins are required for optimal therapy. ( info) |
10/745. Microsphaeropsis olivacea as an etiological agent of human skin infection. Microsphaeropsis olivacea is reported as the agent of a case of human skin infection in an otherwise healthy woman. This fungus has not been reported previously as causing disease in humans. It was identified on the basis of its production of pycnidia and conidial structures typical of the Coelomycetes, and by its light brown, ellipsoid to cylindrical and thick walled conidia. The in vitro inhibitory activity of amphotericin b, fluconazole, flucytosine, itraconazole, ketoconazole and miconazole was determined. ( info) |