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      Three rare cases of cutaneous phaeohyphomycosis

      case-report

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          Abstract

          Phaeohyphomycosis is a chronic infectious condition caused by dematiaceous fungi which usually involve the skin and subcutaneous tissue. Subcutaneous phaeohyphomycosis is characterised by papulonodules, verrucous, hyperkeratotic or ulcerated plaques, cysts, abscesses, pyogranuloma, non-healing ulcers or sinuses. In India, commonly associated genera are Exophiala, Phialophora, Cladosporium, Curvularia, Fonsecaea and Alternaria. This condition involves the presence of brown-walled hyphal structures in the dermis and epidermis. Here, we are reporting a rare case series of three patients of phaeohyphomycosis with lesions on finger and dorsum of the hand.

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          Dematiaceous fungi.

          Gajanan S. Revankar (2007)
          Dematiaceous fungi are responsible for a wide variety of infectious syndromes. They are often found in soil and generally distributed worldwide. This suggests that most if not all individuals are exposed to them, presumably from inhalation or trauma. In recent years, these fungi have been increasingly recognised as important pathogens. The spectrum of diseases they are associated with has also broadened and includes superficial and deep local infections, allergic disease, pneumonia, brain abscess and disseminated infection. For some infections in immunocompetent individuals, such as allergic fungal sinusitis and brain abscess, they are among the most common aetiological agents. These fungi may have unique pathogenic mechanisms owing to the presence of melanin in their cell walls, which imparts the characteristic dark colour to their spores and hyphae. Diagnosis rests on careful microscopical and pathological examination, as there are no simple laboratory tests to reliably identify these fungi. Therapy depends upon the clinical syndrome. Local infection may be cured with excision alone, while systemic disease is often refractory to therapy. Azoles such as itraconazole and voriconazole have the most consistent in vitro activity, though there is more clinical experience with itraconazole. Further studies are needed to better understand the pathogenesis and optimal treatment of these uncommon infections.
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            Subcutaneous phaeohyphomycosis (mycotic cyst).

            Rafael Isa-Isa, Carlos Garcia, Mariel Isa … (2012)
            Phaeohyphomycosis designates fungal infections caused by pheoid or melanized fungi and characterized histopathologically by the presence of septate hyphae, pseudohyphae, and yeasts. Etiologic agents include Exophiala, Phoma, Bipolaris, Phialophora, Colletotrichum, Curvularia, Alternaria, Exserohilum, and Phialemonium sp. The most common are Exophiala jeanselmei and Wangiella dermatitidis. The clinical presentation depends on the immune status of the host: superficial (tinea nigra and black piedra); cutaneous (scytalidiosis) and corneal; subcutaneous (mycotic cyst); and systemic phaeohyphomycosis in the immunocompromised host. The mycotic cyst is a localized form, characterized by subcutaneous asymptomatic nodular lesions that develop after traumatic implantation of fungi, especially on the extremities. The average size of the cysts is 2.5 cm. KOH examination reveals pigmented yeasts, pseudohyphae, and hyphae. A cutaneous biopsy specimen usually shows an abscess or a suppurative granuloma with pigmented yeasts and pseudohyphae. The treatment of choice is surgical excision, but additional anti-fungal therapy is recommended for recurrent cases and immunocompromised patients.
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              Molecular and phenotypic characterization of Phialemonium and Lecythophora isolates from clinical samples.

              Emily R. Summerbell, D. Sutton, Jessica Fothergill … (2011)
              Several members of the fungal genera Phialemonium and Lecythophora are occasional agents of severe human and animal infections. These species are difficult to identify, and relatively little is known about their frequency in the clinical setting. The objective of this study was to characterize morphologically and molecularly, on the basis of the analysis of large-subunit ribosomal DNA sequences, a set of 68 clinical isolates presumed to belong to these genera. A total of 59 isolates were determined to be Phialemonium species (n = 32) or a related Cephalotheca species (n = 6) or Lecythophora species (n = 20) or a related Coniochaeta species (n = 1). Nine isolates identified to be Acremonium spp. or Phaeoacremonium spp. were excluded from further study. The most common species were Phialemonium obovatum and Phialemonium curvatum, followed by Lecythophora hoffmannii, Cephalotheca foveolata, and Lecythophora mutabilis.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Indian J Plast Surg
                Journal ID (iso-abbrev): Indian J Plast Surg
                Journal ID (publisher-id): IJPS
                Title: Indian Journal of Plastic Surgery : Official Publication of the Association of Plastic Surgeons of India
                Publisher: Medknow Publications & Media Pvt Ltd (India )
                ISSN (Print): 0970-0358
                ISSN (Electronic): 1998-376X
                Publication date (Print): May-Aug 2016
                Volume: 49
                Issue: 2
                Pages: 271-274
                Affiliations
                [1]Department of Dermatology, Topiwala National Medical College and B. Y. L. Nair Hospital, Mumbai, Maharashtra, India
                Author notes
                Address for correspondence: Dr. Aditi Chhonkar, Department of Skin and VD, Topiwala National Medical College and B. Y. L. Nair Hospital, OPD Building, Second Floor, OPD-14, Mumbai - 400 008, Maharashtra, India. E-mail: aditichhonkar@ 123456gmail.com
                Article
                Publisher ID: IJPS-49-271
                DOI: 10.4103/0970-0358.191321
                PMC ID: 5053006
                PubMed ID: 27833296
                SO-VID: 02e21365-7fd4-4c99-bc07-6b46099a28e3
                Copyright © Copyright: © Indian Journal of Plastic Surgery
                License:

                This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

                History
                Categories
                Subject: Case Report

                ScienceOpen disciplines: Surgery
                Keywords: dematiaceous fungi,dorsum of hand,fungal infection,phaeohyphomycosis
                Data availability:
                ScienceOpen disciplines: Surgery
                Keywords: dematiaceous fungi, dorsum of hand, fungal infection, phaeohyphomycosis

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