Chronic infection due to Fusarium oxysporum mimicking lupus vulgaris: case report and review of cutaneous involvement in fusariosis.

A 67-year-old female presented with a 20-year-old lesion involving the right ear and preauricular area mimicking tuberculous lupus. Fusarium oxysporum infection was confirmed by biopsy studies and cultures. The biopsy specimen showed an unusually extensive dermal invasion with fungal hyphae. This is an uncommon clinical presentation for Fusarium infection in a healthy patient. When referred to us, the patient had received antifungal therapy with itraconazole without any benefit. Improvement was obtained with fluconazole therapy. The spectrum of cutaneous involvement related to Fusarium spp. includes toxic reactions, colonization, superficial indolent infection, deep cutaneous or subcutaneous infections and disseminated infection.     

SYSTEMIC KETOCONAZOLE TREATMENT FOR FUSARIUM LEG ULCERS

Fusarium oxysporum was isolated from a large foot ulcer in an otherwise healthy 69-year-old man. Although tissue invasion could not be proven histologically, systemic antifungal treatment was administered with satisfactory response. Fusarium species are common soil-inhabiting organisms and plant pathogens. In humans, Fusarium is considered an opportunistic agent in skin ulcers, interdigital spaces, and burned skin, but can also cause mycotic keratitis, onychomycosis, and rarely deep-seated or disseminated infections, especially in an immunocompromised host. The distinction between skin infection and saprophytic growth, as well as optimal treatment regimens for the two types of infection, have not been clearly defined. We describe a case of leg ulcers caused by Fusarium oxysporum in a 69-year-old man treated successfully with oral ketoconazole. "Silent" immunologic disturbances were found in this apparently healthy patient. The case illustrates a relatively benign infection caused by Fusarium that responded to systemic antifungal drug treatment.     

Skin infection with Fusarium in an immunocompetent patient

Fusarium spp. are fungi found throughout the world and can cause a great variety of skin infections, mainly in immunodepressed individuals. We present a case of skin infection with Fusarium sp. which manifested as painful superficial ulcers on the legs of an immunocompetent female patient, who had applied as a for leg pain. The condition was cured with oral itraconazole and local treatments.     

Disseminated Fusarium solani Infection With Cutaneous Nodules in a Bone Marrow Transplant Patient

Fusarium is a ubiquitous fungus that commonly colonizes ulcerated, burned, or traumatized skin and may cause keratitis and onychomycosis in healthy hosts. Serious disseminated infection due to Fusarium has been reported with increasing frequency in immunocompromised patients. We describe a bone marrow transplant patient who developed fungal septicemia and disseminated skin nodules due to Fusarium solani. Fusarium should be recognized as a potential cause of deep fungal infection in immunocompromised patients.     

Disseminated hyalohyphomycosis in a leukemic patient

A 69-year-old man with acute myeloblastic leukemia was admitted to the hospital for induction chemotherapy. A complication caused by a disseminated mycotic infection occurred while the neutropenic patient was maintained on a course of cytotoxic drugs, antibiotics, and corticosteroid therapy. The causal isolate was identified as Fusarium solani on the basis of its colonial and microscopic morphology. This fungus developed in the patient's tissue in the form of hyaline, branched, septate hyphae. This case fits the definition of the disease entity known as hyalohyphomycosis. The term hyalohyphomycosis encompasses infections caused by various nondematiaceous opportunistic fungi with a filamentous tissue form. The purpose of this article is to review and discuss the literature on hyalohyphomycosis caused by Fusarium species. Combined histopathologic and mycologic findings were evaluated to determine the nature of opportunistic mycotic infections.     

Fusarium fingernail infection responsive to fluconazole intermittent therapy

A case of fingernail infection by Fusarium is presented. This nondermatophytic mold is an infrequent cause of onychomycosis, more typically involving the great toenail. Characteristic histologic features including the presence of hyphae and chlamydoconia are helpful in rapid diagnosis and selection of appropriate antifungal therapy. Although Fusarium has shown resistance to most antifungal medications in vitro, intermittent therapy with fluconazole led to improvement in this patient.     

UNUSUAL FUNGAL INFECTIONS ASSOCIATED WITH IMMUNOLOGIC HYPOREACTIVITY

Two patients had unusual fungal infections, considered to be contaminants, which suggested immunologic hyporeactivity. One patient with a Fusarium infection had an associated occult malignancy. The other patient had an initial localized, then disseminated Curvularia infection. Both patients, following analysis of subpopulations of lymphocytes, showed evidence of relative T and B cell defects.     

Cutaneous infection caused by Fusarium solani and Fusarium oxysporum

A case of cutaneous infection by Fusarium solani and Fusarium oxysporum on the middle finger of the right hand of a 58-year-old farmer is reported. On the extensor aspect of the distal phalanx of the middle finger, there was a pale reddish, edematous lesion with some vesicles, pustules, and an ulcer. Scrapings from the lesion showed fungal elements on direct microscopic examination, and Fusarium solani and Fusarium oxysporum were identified on slide culture. Hyperthermia treatment with a chemical pocket warmer led to conspicuous healing of the lesion.     

Nasal Cutaneous Infection in a Healthy Boy Caused by Fusarium moniliforme

A healthy 10‐year‐old Chinese boy developed verrucous plaques on the nose. The fungus was identified as Fusarium moniliforme via culture of biopsy fragments. The patient had normal immune status and was successfully treated with oral itraconazole (100 mg/day) for 2 months and application of oral itraconazole and topical sertaconazole nitrate cream. Fusarium is a ubiquitous hyalohyphomycete isolated from food that is also widespread in the environment and is present at all latitudes. Infections due to this mold may be disseminated or localized. Fusarium species have been known to colonize the cornea, nails, and burn eschars in otherwise healthy patients. Cutaneous and disseminated infections have been reported mostly in immunocompromised hosts. Here we describe an unusual case of localized infection caused by Fusarium moniliforme in an otherwise healthy child, with significant improvement after 2 months of oral itraconazole and topical sertaconazole nitrate cream therapy.     

镰刀菌皮肤肉芽肿1例

报告1例镰刀菌皮肤肉芽肿。患者男,21岁。面部出现红斑、丘疹、溃烂、结痂20年,四肢皮肤疣状增生3年,面部遗留毁容性瘢痕及组织缺损。多次取不同皮损处皮屑作真菌培养,均见相同菌落生长,经菌种鉴定为镰刀菌属。皮损组织病理学检查示表皮乳头瘤样增生,表皮浅层见多量菌丝,菌丝有分隔。流式细胞仪检测发现患者细胞免疫功能低下。根据药敏试验结果采用特比萘芬治疗,其疗效正在进一步随访观察中。     

Complete cure of Fusarium solani sp. complex onychomycosis with Qs NdYAG treatment

The incidence of non dermatophytic mould (NDM) onychomycosis (OM) has been steadily increasing Fusarium spp is the most common cause of NDM OM in most geographical locations. Fusarium spp and other NDMs are largely resistant to commonly used anti‐fungals. The successful use of laser and light based devices has been demonstrated in dermatophytic OM, but there is no previous report of their successful use in any NDM OM. We describe a patient with OM caused by Fusarium solani spp, who was clinically (with a normal appearing nail) and mycologically (with negative microscopy and culture on repeated samples) cured of her infection following treatment with 2 sessions of Qs NdYAG (532nm and 1064nm) given 1 month apart.     

Plantar hyperkeratosis due to Fusarium verticillioides in a patient with malignancy

We report the case of an 82-year-old man with hyperkeratosis of the right sole caused by a Fusarium verticillioides infection mimicking verrucous tuberculosis; the infection was confirmed by direct potassium hydroxide microscopy, biopsy and cultures. The biopsy specimen showed an unusually deep invasion of fungal elements into the epidermis. This is an uncommon presentation in a localized cutaneous infection by Fusarium but in this case, repeated local injuries were the portal of entry initiating the process. Clinical patterns of cutaneous fusarium infections in general are also discussed.     

由胶孢镰刀菌所致足部皮肤无色丝孢霉病一例

目的 报道1例由胶孢镰刀菌所致足部无色丝孢霉病。方法 询问病史及体检，取右足内踝处皮损常规病理检查。取皮损分泌物行10% KOH真菌直接镜检和培养，鉴定菌种。结果 患者女，72岁，右足溃疡3年。检查见右足踝内侧皮肤约3 cm × 1.5 cm溃疡，基底暗红色肉芽组织增生，表面湿润，触痛明显。溃疡皮损组织病理检查，真皮浅层肉芽组织坏死，有细长、分隔、无色菌丝样结构物，其周围组织伴有慢性炎症细胞散在浸润，PAS染色显示腊肠样菌丝及散在卵圆形真菌孢子。皮损分泌物真菌镜检见分隔、分支无色菌丝。分离菌株经培养及鉴定为胶孢镰刀菌。本菌株对特比萘芬、制霉菌素及两性霉素B高度敏感。给予口服特比萘芬0.25 g，每日2次，2个月后病灶完全愈合。结论 本病例为胶孢镰刀菌所致足部皮肤无色丝孢霉病，特比萘芬治疗有效。     

Cutaneous Fusarium Infection in an Adolescent with Acute Leukemia

Disseminated fusariosis occurred in a pediatric patient with acute lymphocytic leukemia in relapse. The patient had fever and neutropenia, and scattered violaceous papules and vesicles with central erosions that rapidly progressed to generalized, painful, violaceous, papulovesicular lesions with central necrosis. Severe myalgias were associated. The diagnosis was suspected by noting hyphae on a smear of vesicular contents, and confirmed by culture. The clinical course was rapidly fatal despite early institution of amphotericin B therapy. Disseminated Fusarium infection should be suspected in immunocompromised patients with fever and neutropenia who have generalized, eroded, violaceous papules, vesicles, and pustules, particularly with associated myalgias.     

Deep cutaneous infection by Fusarium solani in a healthy child: successful treatment with local heat therapy

We describe a 6-year-old boy with a granulomatous lesion on the upper aspect of his left arm. Fusarium solani infection was confirmed by biopsy studies and cultures. The biopsy specimen showed an unusually extensive dermal invasion with fungal hyphae. This is an uncommon clinical presentation for deep cutaneous infection caused by F solani in a healthy child. Local heat therapy with a chemical pocket warmer led to dramatic healing of the lesion.     

Fusariosis occurring in an ulcerated cutaneous CD8+ T cell lymphoma tumor

Fusarium species have recently emerged as the second most common pathogenic mold in immunocompromised patients, and they are moderately resistant to most antifungal agents. The skin lesions of disseminated fusariosis typically manifest as multiple red or violaceous macules or nodules, often ulcerated and covered by a black eschar. We report a case of cutaneous fusariosis in a patient with long-standing hypopigmented mycosis fungoides. The infection was successfully treated with a 3-month course of oral voriconazole. The present case is unusual in that the infection occurred within a pre-existing, ulcerated lesion of cutaneous CD8+ lymphoma, resulting clinically in confusion with pyoderma gangrenosum and necrosis of lymphoma. A high index of suspicion will prompt a timely biopsy as well as isolation of the fungus, and early institution of systemic antifungal therapy.     

儿童皮肤串珠镰刀菌病

报告1例儿童皮肤镰刀菌病。患儿女,15岁。面部浅表溃疡、小脓疱10年,自幼经常发热,肺部感染,存在细胞免疫功能低下。皮损痂皮和组织镜检、培养和组织病理学检查证实为串珠镰刀菌感染。诊断为限局性皮肤串珠镰刀菌病。经手术切除皮损联合口服特比萘芬治愈。     

Disseminated cutaneous and visceral fusariosis in an aplastic patient: an unusual digestive entry

INTRODUCTION: The hyalohyphomycetes, Fusarium spp, are very common in our environment. Some of them have been recognized as being opportunistic agents responsible for localized as well as generalized infections, especially in the case of malignant blood diseases. Their poor sensitivity to standard antifungal therapeutics makes them very dangerous. We report a case of cutaneous and systemic fusariosis due to Fusarium moniliforme in a patient with acute lymphoblastic leukemia. CASE-REPORT: A 20 year-old male student was suffering from acute type 6 myeloblastic leukemia. During the second consolidation schedule with a combined therapy of aracytine and amsacrine, this patient whose food diet was exclusively based on cereals, showed evidence of febrile aplasia, associated with myalgia, abdominal pain and diarrhoea. Microbiological samples were sterile. Ten days later, we noted the appearance of painful, diffuse and purple dermohypodermal cutaneous nodules surrounded by an erythematous ring. Histological and microbiological examination of the hypodermis biopsies of the skin nodules revealed invasion by Fusarium moniliforme. Treatment with voriconazole in association with transfusions of leukocytes led to clinical and microbiological cure. DISCUSSION: In our case report, the clinical pattern starting with digestive symptoms suggested dissemination from a digestive site, which is very unusual in Europe. In our patient, the malnutrition, together with a diet exclusively based on contaminated cereals in a context of malignant hemopathy, resulted in the colonization of the digestive tract by these moulds and the aplasia-inducing chemotherapy schedules enhanced their pathogen potential.     

茄病镰刀菌引起儿童角膜溃疡1例

报告茄病镰刀菌引起的儿童角膜溃疡1例。患儿男,7岁,学生。因右眼红肿、疼痛13天之主诉入院。从皮损处取材做真菌检查,直接镜检发现真菌菌丝,3次培养均为同一菌株生长,依据小培养镜下特征鉴定为茄病镰刀菌。依据临床表现及实验室检查诊断为茄病镰刀菌引起的真菌性角膜溃疡。     

镰刀菌致急性真菌性角膜炎

报告1例茄病镰刀菌致急性真菌性角膜炎.患者女,31岁,农民.左眼视力下降,伴红肿、疼痛、畏光、流泪2周.经角膜分泌物真菌镜检及培养证实为茄病镰刀菌,经系统治疗后临床症状明显好转,目前仍在随访中.