A patient with severe rheumatoid arthritis treated with prednisone had a painless soft tissue nodule develop on the dorsal aspect of the ring finger. She denied any history of hand trauma, animal exposure, or systemic symptoms such as fever or malaise. Fungal cultures performed on an aseptically obtained aspirate of this lesion demonstrated dark, olive-black creamy colonies on Sabouraud's agar. Slide cultures made from mold colonies produced slender conidial forms with annellations and spine-like conidiophores, features characteristic of Exophiala spinifera. The lesion was surgically excised, and the patient was successfully treated with a course of oral itraconazole. This nodular lesion has not recurred at the time of this writing. Exophiala species are difficult to differentiate, and E. spinifera may be confused with Exophiala jeanselmei. A literature review will consider Exophiala species and clinical manifestations produced by these dematiaceous fungi.
[Show abstract][Hide abstract] ABSTRACT: Exophiala spinifera, one of the etiologic agents of subcutaneous phaeohyphomycosis, may be wrongly identified as Exophiala jeanselmei because of the morphologic similarity of the two species. A reagent containing a precipitin specific for E. spinifera was produced by absorbing antiserum to E. spinifera with E. jeanselmei serotype 1 antigen. Using this absorbed antiserum, we were able to correctly identify isolates of E. spinifera and differentiate them from those of Exophiala alcalophila, E. jeanselmei (serotypes 1, 2 and 3), Exophiala moniliae, Exophiala pisciphila, Exophiala salmonis, Phaeoannellomyces werneckii and Wangiella dermatitidis.
Journal of medical and veterinary mycology: bi-monthly publication of the International Society for Human and Animal Mycology 02/1991; 29(4):273-7. DOI:10.1080/02681219180000401
[Show abstract][Hide abstract] ABSTRACT: Phaeohyphomycosis caused by Exophiala species is an unusual infection, but it has been reported with increasing frequency as immunosuppressive therapy has become more widespread and laboratory methods for diagnosis have improved. To our knowledge, the first case of subcutaneous phaeohyphomycosis due to Exophiala jeanselmei in a cardiac transplant patient is presented, and previously reported cases of exophiala infection are reviewed. This patient was successfully managed with surgical excision of the lesion and combination therapy with amphotericin B and 5-fluorocytosine.
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