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      Cutaneous Phaeohyphomycosis Presenting as a Progressive Disfiguring Lesion of the Face in an Immunocompetent Individual; A Rare Occurrence

      case-report

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          Abstract

          Phaeohyphomycosis encompasses many clinical syndromes occurring due to a wide variety of dematiaceous fungi. It can manifest as superficial, cutaneous, subcutaneous, or systemic forms involving the skin, subcutis, paranasal sinuses, or the central nervous system. Subcutaneous phaeohyphomycosis is the most common subtype and occurs due to wound contamination or traumatic inoculation of the saprophytic fungus from soil and vegetation. Multiple cases of subcutaneous phaeohyphomycosis involving the extremities in the form of cystic lesions and abscesses have been reported. However, involvement of the face in the form of a progressive ulcerative and disfiguring lesion in an immunocompetent person is extremely rare. We report a rare case of subcutaneous phaeohyphomycosis presenting as a slowly progressive disfiguring lesion of face.

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          Most cited references10

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          New Panfungal Real-Time PCR Assay for Diagnosis of Invasive Fungal Infections.

          The diagnosis of invasive fungal infections (IFIs) is usually based on the isolation of the fungus in culture and histopathological techniques. However, these methods have many limitations often delaying the definitive diagnosis. In recent years, molecular diagnostics methods have emerged as a suitable alternative for IFI diagnosis. When there is not a clear suspicion of the fungus involved in the IFI, panfungal real-time PCR assays have been used, allowing amplification of any fungal DNA. However, this approach requires subsequent amplicon sequencing to identify the fungal species involved, increasing response time. In this work, a new panfungal real-time PCR assay using the combination of an intercalating dye and sequence-specific probes was developed. After DNA amplification, a melting curve analysis was also performed. The technique was standardized by using 11 different fungal species and validated in 60 clinical samples from patients with proven and probable IFI. A melting curve database was constructed by collecting those melting curves obtained from fungal species included in the standardization assay. Results showed high reproducibility (coefficient of variation [CV] 0.95) and specificity (100%). The overall sensitivity of the technique was 83.3%, with the group of fungi involved in the infection detected in 77.8% of the positive samples with IFIs covered by molecular beacon probes. Moreover, sequencing was avoided in 67.8% of these "probe-positive" results, enabling report of a positive result in 24 h. This technique is fast, sensitive, and specific and promises to be useful for improving early diagnosis of IFIs.
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            Hyalohyphomycosis and phaeohyphomycosis: two global disease entities of public health importance.

            L Ajello (1986)
            Two relatively new opportunistic diseases--hyalohyphomycosis and phaeohyphomycosis--are the byproduct, in most cases, of the progress being made in combating microbial and non-microbial diseases. Immunologically impaired hosts have become vulnerable to infection by fungi that were long considered to be innocuous. The currently known etiologic agents of these two diseases are listed and pertinent literature references are cited. The basic histologic differences between phaeohyphomycosis and chromoblastomycosis was emphasized and illustrated.
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              Phaeohyphomycosis.

              G Rinaldi (1995)
              Mycoses caused by dematiaceous (darkly pigmented) fungi are escalating in contemporary medicine. Such fungal infections are properly termed phaeohyphomycosis and are of increasing concern to dermatologists. A high index of suspicion, knowledge of clinical and laboratory presentations, enhanced mycologic attention, and an awareness of current therapeutic modalities--surgical and chemotherapeutic--may offer optimal management strategies for patients experiencing this type of often unique mycotic infection.
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                Author and article information

                Journal
                Indian Dermatol Online J
                Indian Dermatol Online J
                IDOJ
                Indian Dermatology Online Journal
                Wolters Kluwer - Medknow (India )
                2229-5178
                2249-5673
                Nov-Dec 2020
                08 November 2020
                : 11
                : 6
                : 975-978
                Affiliations
                [1] Department of Dermatology, Base Hospital, Lucknow, Uttar Pradesh, India
                [1 ] Department of Dermatology, Military Hospital Kirkee, Pune, Maharashtra, India
                [2 ] Department of Pathology, Command Hospital, Lucknow, Uttar Pradesh, India
                [3 ] Department of Radiology, Military Hospital Kirkee, Pune, Maharashtra, India
                [4 ] Department of Dermatology, Base Hospital, Delhi Cantt, New Delhi, India
                Author notes
                Address for correspondence: Dr. Anwita Sinha, Department of Dermatology, Military Hospital, Kirkee, Pune, Maharashtra, India. E-mail: anwita.afmc@ 123456gmail.com
                Article
                IDOJ-11-975
                10.4103/idoj.IDOJ_220_20
                7735003
                0a74f183-2ed9-4782-80f2-00994b384e47
                Copyright: © 2020 Indian Dermatology Online Journal

                This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

                History
                : 09 April 2020
                : 10 July 2020
                : 16 August 2020
                Categories
                Case Report

                Dermatology
                dematiaceous fungi,disfiguring lesion of the face,phaeohyphomycosis
                Dermatology
                dematiaceous fungi, disfiguring lesion of the face, phaeohyphomycosis

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