RESUMO
Abstract We report a rare case of subcutaneous phaeohyphomycosis caused by Cladophialophora bantiana in an immunocompetent patient in Amazonas, Brazil. This dematiaceous fungus has been mainly associated with life-threatening infections affecting the central nervous systems of immunosuppressed patients. We present the clinical, laboratory, and therapeutic aspects, and in vitro susceptibility test results for different antifungal drugs. A brief review of the cases reported in the literature over the past 20 years has also been discussed. According to the literature review, the present case is the first report of subcutaneous phaeohyphomycosis due to C. bantiana in an immunocompetent patient in Latin America.
Assuntos
Humanos , Masculino , Ascomicetos/isolamento & purificação , Feoifomicose , Feoifomicose/diagnóstico , Biópsia , Brasil , Hospedeiro Imunocomprometido , Dermatomicoses/tratamento farmacológico , Fungos Mitospóricos/isolamento & purificação , Feoifomicose/imunologia , Feoifomicose/tratamento farmacológico , Pessoa de Meia-Idade , Antifúngicos/classificação , Antifúngicos/uso terapêuticoRESUMO
Las feohifomicosis comprenden un grupo de infecciones causadas por hongos pigmentados, negros o dematiáceos. En las últimas dos décadas se ha incrementado la frecuencia de reportes y la diversidad de los agentes etiológicos implicados, especialmente en los individuos inmunosuprimidos. Los principales géneros involucrados incluyen Alternaria, Bipolaris, Cladophialophora y Exophiala. Estos hongos típicamente se encuentran en el suelo y son introducidos al cuerpo a través de la inhalación o el trauma. El espectro de las enfermedades asociadas también se ha ampliado e incluye infecciones cutáneas superficiales y profundas, enfermedad alérgica, neumonía, abscesos cerebrales e infección diseminada. El diagnóstico de laboratorio está basado en las características morfológicas de los agentes según lo observado en el examen microscópico directo y la histopatología. El tratamiento es a menudo difícil y depende del síndrome clínico. No hay terapias estandarizadas, pero voriconazol, posaconazol e itraconazol han demostrado la actividad in vitro más consistente contra este grupo de hongos. La rareza de estas micosis justifica describir las características clínicas, epidemiológicas y diagnósticas para ayudar a un reconocimiento inmediato y un tratamiento oportuno
Phaeohyphomycosis comprises a group of infections caused by black pigmented or dematiaceous fungi. In the last two decades the frequency of reporting and diversity of etiologic agents involved have increased, especially in immunosuppressed individuals. The main genera involved include Alternaria, Bipolaris, Cladophialophora and Exophiala. These fungi are typically found in the soil and introduced through inhalation or trauma. The spectrum of associated diseases also has broadened and includes superficial and deep cutaneous infections, allergic disease, pneumonia, brain abscess and disseminated infection. The laboratory diagnosis is based on the morphological characteristics of the agents as observed by direct microscopic examination and histopathology. Treatment is often challenging and depends uponthe clinical syndrome. There are no standardized therapies but voriconazole, posaconazole and itraconazole demonstrate the most consistent in vitro activity against this group of fungi. The rarity of this mycosis justifies describe the clinical, epidemiological and diagnostic characteristics to aid in its immediate recognition and early treatment
RESUMO
Se presenta un caso de Feohifomicosis subcutánea en un paciente joven inmunocompetente, localizada en cara flexora de antebrazo derecho, sin antecedente previo de traumatismo evidenciado por él mismo. Al examen físico presentaba lesiones nodulares y supurativas que al biopsiarlas evidenciaron intensa inflamación granulomatosa, con sectores de fibrosis y extensas áreas de necrosis. Luego se realizaron cultivos y estudios micológicos específicos, dando como diagnóstico una Feohifomicosis subcutánea por Exophiala dermatitidis. El tratamiento consistió en administración de itraconazol más resección quirúrgica completa, sin evidenciar recidivas a los seis meses del control posterior al tratamiento.
In this case we have examined a young male immunocompetent patient suffering from subcutaneous phaeohyphomycosis on his right forearm. Upon questioning, the patient did not express having noticed any previous traumatism. Physical examination revealed suppurative nodular lesions which, in the histologic study, showed severe granulomatous inflammation along with fibrotic tissue and necrosis. We carried out the corresponding cultures, the results of which was Exophila dermatitidis, and subcutaneous phaeohyphomycosis was diagnosed. The treatment of choice consisted in itraconazole and a surgical procedure to remove the lesion. Six months after the procedure, we have found no sings of the disease.