Pheohyphomycosis caused by Exophiala spinifera: a rare occurrence

Area of Science:

• Medical Mycology
• Dermatology
• Infectious Diseases

Background:

• Exophiala spinifera is a fungus known to cause phaeohyphomycosis, a group of infections.
• Phaeohyphomycosis can present with varied clinical manifestations, particularly in immunocompetent individuals.
• Treatment of Exophiala spinifera infections can be challenging due to variable antifungal susceptibility.

Observation:

• A 10-year-old immunocompetent boy developed multiple, verrucous, disseminated skin lesions.
• The lesions were diagnosed as phaeohyphomycosis caused by Exophiala spinifera.
• The patient exhibited a lack of response to a combination of antifungal medications (itraconazole, terbinafine, fluconazole) and cryotherapy.

Findings:

• Standard combination antifungal therapy and cryotherapy were ineffective in treating the disseminated Exophiala spinifera infection.
• The case underscores the potential for treatment resistance in Exophiala spinifera infections.
• In vitro antifungal susceptibility testing is crucial for guiding effective treatment strategies.

Implications:

• This case highlights the importance of considering Exophiala spinifera in the differential diagnosis of disseminated fungal skin lesions.
• Antifungal susceptibility testing should be routinely performed for Exophiala spinifera infections to guide therapy.
• Further research into effective treatment modalities for recalcitrant Exophiala spinifera infections is warranted.