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Disseminated pheohyphomycosis.

Kanakapura N Shivaswamy1, Prashanth Pradhan, Chandrashekar Laxmisha

  • 1Department of Dermatology and Sexually Transmitted Diseases, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India.

International Journal of Dermatology
|March 9, 2007
PubMed
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This case study describes a disseminated subcutaneous pheohyphomycosis infection in an immunocompromised agricultural worker. The patient presented with multiple skin lesions and neurological symptoms, successfully treated with itraconazole.

Area of Science:

  • Medical Mycology
  • Infectious Diseases
  • Dermatology

Background:

  • Pheohyphomycosis is a fungal infection caused by pigmented fungi.
  • Disseminated disease is rare, particularly in immunocompromised individuals.

Observation:

  • A 40-year-old male agricultural laborer on long-term oral steroids presented with asymptomatic, progressive subcutaneous swellings on his left hand and leg.
  • Physical examination revealed multiple, mobile, cystic lesions of varying sizes.
  • The patient also had decreased breath sounds and was found to have hyperglycemia (random blood glucose >400 mg%).

Findings:

  • Histopathology and special stains (GMS, Masson-Fontana) confirmed pheohyphomycosis, revealing melanin-producing fungal hyphae within cystic lesions.
  • Chest X-ray showed pulmonary nodules, and a CT scan of the brain revealed multiple ring-enhancing lesions.

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  • Diagnosis of disseminated subcutaneous pheohyphomycosis was established.

    • Implications:

    • This case highlights the importance of considering pheohyphomycosis in immunocompromised patients with subcutaneous lesions and systemic symptoms.
    • Early diagnosis and treatment with antifungal agents like itraconazole are crucial for managing disseminated disease.
    • The study underscores the potential for subcutaneous fungal infections to disseminate to the central nervous system.