Subcutaneous phaeohyphomycosis

Abstracts

São apresentadas imagens ilustrativas de um caso de feoifomicose subcutânea causada pela Exophiala jeanselmei num paciente transplantado renal. Breves comentários sobre a doença encontram-se no texto. Ressalta-se a necessidade de essa micose entrar no diagnóstico diferencial de outras dermatoses, inclusive as não infecciosas.

Exophiala; Micoses; Transplante de rim

IMAGES IN TROPICAL DERMATOLOGY

Subcutaneous phaeohyphomycosis^*

Rosane Orofino Costa

PhD, Adjunct Professor of Dermatology, School of Medical Sciences, State University of Rio de Janeiro (UERJ). Head of the Mycology Laboratory, Pedro Ernesto Teaching Hospital, Rio de Janeiro, RJ, Brazil

Mailing address

ABSTRACT

This report shows images of a case of subcutaneous phaeohyphomycosis caused by Exophiala jeanselmei in a patient who has undergone renal transplantation. The paper comments briefly on the disease and emphasizes the need to take this mycosis into account in the differential diagnosis of other dermatoses, including non-infectious dermatoses.

Keywords: Exophiala; Kidney transplant; Mycoses

Phaeohyphomycosis was a nomenclature proposed by Ajello in 1975¹ and later modified by McGinnis in 1983². The term phaeohyphomycosis defines the diseases caused by fungi growing in the infected tissue as irregular septate brownish hyphae and/or toruloid hyphae, as well as fungal elements with germination (Figure 1). The term should not substitute well-established diseases such as tinea nigra, black piedra or chromomycosis.³ Cases most often present as cutaneous, subcutaneous or systemic skin abscesses and may affect immunologically competent or incompetent individuals. The most common form of presentation is the subcutaneous type, which should form part of the differential diagnosis of several dermatoses including tumoral forms. In the case presented here, the lesion resembles a mycetoma or epidermoid carcinoma (Figure 2). The most common etiological agents are the Exophiala species (Figure 3). ⁴ Due to the diversity of the etiological agents, hosts and forms of clinical presentation, treatment remains difficult. When the lesion is subcutaneous and well localized, complete surgical removal of the lesion is recommended (Figure 4). If necessary, broad-spectrum antifungal medication may be used, although care must be taken with immunodepressed patients in the case of possible side effects and drug interactions. ⁵

REFERENCES

• 1. Ajello L. Phaeohyphomycosis: definition and etiology. In: International Conference on the Mycoses. Proceedings, Washington: PAHO, Scient Publ, 1975, 304. p.126-30.
• 2. McGinnis MR. Chromoblastomycosis and phaeohyphomycosis: new concepts, diagnosis and mycology. J Am Acad Dermatol. 1983;8:1-16.
• 3. Matsumoto T, Ajello L. Agents of Phaeohyphomycosis. In: Ajello L, Hay RJ, editors. Medical Mycology. Londres: Arnold; 1998. p. 503-24.
• 4. Lacaz CS, Porto E, Martins JEC, Heins-Vaccari EM, Melo NT. Feo-hifomicose. In: Lacaz CS. Tratado de Micologia Médica. São Paulo: Sarvier; 2002. p. 520-61.
• 5. Kwon-Chung KJ, Bennett JE. Phaeohyphomycosis. In: Kwon-Chung KJ, Bennett JE. Medical Mycology. Philadelphia: Lea & Febiger; 1992. p.620-77.

*

Trabalho realizado no Serviço de Dermatologia, Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro (UERJ) - Rio de Janeiro (RJ), Brasil.

Publication Dates

• Publication in this collection
  02 Dec 2010
• Date of issue
  Oct 2010

History

• Received
  18 Aug 2010