Phaeohyphomycosis caused by Exophiala species in immunocompromised hosts

Exophiala species are rarely implicated in clinical diseases. In the past 2 years, we have treated phaeohyphomycosis caused by Exophiala species in three immunocompromised patients. Two of these patients presented with subcutaneous abscess or cutaneous verrucous lesions due to Exophiala jeanselmei. The former, an 81-year-old woman, had pulmonary tuberculosis and the latter, a 62-year-old man, had undergone heart transplantation and was receiving immunosuppressive treatment. The third patient, a 62-year-old woman, had acute lymphoblastic leukemia and developed lymphadenitis due to Wangiella (Exophiala) dermatitidis. In each case, the fungus was discovered on a Gram stain of the aspirated material and was identified by conventional tests. One patient died of bacterial pneumonia with acute respiratory distress syndrome and the other two were treated successfully with surgical excision and antifungal agents. With the more frequent and widespread use of immunosuppressive agents, the incidence of Exophiala infection will certainly increase. Surgical excision or debridement with or without antifungal agents may offer the possibility of cure for phaeohyphomycosis due to Exophiala species.