Subcutaneous phaeohyphomycosis of the finger caused by Exophiala spinifera.
ABSTRACT 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.
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ABSTRACT: Here we report a case of a 55-year-old Indian male presenting with multiple subcutaneous cysts, which developed from painful nodules at the dorsal right wrist joint. Subsequently a painful nodule appeared on the left knee joint. Cytological examination of the knee swelling revealed a suppurative inflammatory lesion consisting of neutrophils, lymphocytes, multinucleated giant cells and few fungal elements, without involvement of the overlying skin. Exophiala spinifera was cultured (CBS 125607) and its identity was confirmed by sequencing of the internal transcribed spacer (ITS rDNA). The cysts were excised surgically, without need of additional antifungal therapy. There was no relapse during one-year follow-up and the patient was cured successfully. In vitro antifungal susceptibility testing showed that posaconazole (0.063 μg/ml) and itraconazole (0.125 μg/ml) had the highest and caspofungin (4 μg/ml) and anidulafungin (2 μg/ml) the lowest activity against this isolate. However, their clinical effectiveness in the treatment of E. spinifera infections remains to be evaluated. In this case report, we have also compiled cases of human E. spinifera mycoses which have been reported so far.Medical mycology: official publication of the International Society for Human and Animal Mycology 09/2011; 50(2):207-13. · 2.13 Impact Factor
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ABSTRACT: We report a case of mucocutaneous phaeohyphomycosis caused by Exophiala spinifera. Crusty plaques and nodules were major clinical features. Histological examination revealed brown yeast-like cells and hyphae. Mycological and molecular data identified E. spinifera as etiologic agent. Oral itraconazole was effective, which was in accordance with the results of in vitro susceptibility testing. We speculated that her pregnancy may play a role of risk factor in the infection by E. spinifera.Mycopathologia 01/2013; · 1.65 Impact Factor
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ABSTRACT: Exophiala spinifera is a rare fungus causing chromoblastomycosis or different types of phaeohyphomycosis (cutaneous, subcutaneous, disseminated and cyst phaeohyphomycosis). We report a case of a young male with phaeohyphomycosis due to E. spinifera, who had multiple itchy painful papular lesions disfiguring his face for 4 years. His diagnosis was delayed and had received antibacterial and antileishmanial therapy elsewhere without any improvement. While he reported to our hospital, the histopathology of the biopsy collected from the lesion demonstrated acute on chronic inflammation with granuloma formation and darkly pigmented fungal elements. The isolate grown on culture was identified as E. spinifera on the basis of morphological characters. The identification of the isolate was further confirmed by sequencing of the ITS region of ribosomal DNA. After treatment with oral itraconazole, he had marked clinical improvement.Mycopathologia 06/2012; 174(4):293-9. · 1.65 Impact Factor