[Cutaneous and osteoarticular Scedosporium apiospermum infection]

Scedosporium apiospermum is a widely distributed fungus that can be found in the soil, manure and decaying vegetation. Human infection with this fungus is facilited by immunodepression. A 65-year-old man, who was taking oral methylprednisolone for rheumatoid polyarthritis had for a few months ulcerated or suppurative nodules whose incision discharged a thick honey-colored exudate. An ulceration over the first right metatarsophalangian articulation had left the bone exposed. The treatment for Pseudomonas aeruginosa, initially isolated in the exudate was unsuccessful. Other microbiology samples exhibited Scedosporium apiospermum, without bacteria. The pathogenic nature of the infection was proven on a skin and bone (head of the first metatarsian) biopsy showing numerous branching and septate hyphae. The patient was successfully treated by itraconazole. Scedosporium apiospermum is the cause of a growing number of human infections due to widespread use of immunosuppressors. Skin and lung localizations predominate. Osteoarticular infection is relatively rare, which contributes to the originality of this observation. Treatment is not well defined and essentially combines surgical drainage with antifungals like itraconazole. This emergent fungal infection, which has non specific clinical manifestations, must be considered in immunocompromised patients.