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Phellinus tropicalis abscesses in a patient with chronic granulomatous disease
Manish Ramesh1, Elena Resnick, Yiqun Hui
1Departments of Medicine and Pediatrics, The Immunology Institute, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, Box 1089, New York, NY, 10029, USA.
Abstract:
Chronic Granulomatous Disease (CGD), caused by genetic defects in components of the phagocyte NADPH oxidase pathway, leads to recurrent life-threatening bacterial and invasive fungal infections. While a number of unique pathogens have been associated with this disease, the causative organisms may be difficult to identify. Here, we present a 24 year old male with known X-linked CGD who concurrently developed a cervical abscess and an abscess in the subcutaneous tissues of the right hip, both of which were surgically drained. Cultures failed to identify any organisms. He was treated empirically with ertapenem but the hip abscess recurred at the original site and in contiguous dependent areas in the posterior thigh and knee. A filamentous organism was observed microscopically, initially considered a contaminant, but on culture yielded a mold growth, identified as Phellinus tropicalis (synonym: Inonotus tropicalis) based on phenotypic and molecular methods. This is the third case report of human infection with P. tropicalis, all in subjects with CGD. The patient was treated with voriconazole with resolution of his symptoms.
Insights
Chronic Granulomatous Disease (CGD) patients face severe infections. A rare mold, Phellinus tropicalis, caused recurrent abscesses in a CGD patient, successfully treated with antifungal medication.
Area of Science:
- Mycology
- Immunology
- Infectious Diseases
Background:
- Chronic Granulomatous Disease (CGD) impairs the immune system, increasing susceptibility to life-threatening bacterial and fungal infections.
- Genetic defects in the phagocyte NADPH oxidase pathway underlie CGD, complicating pathogen identification.
Observation:
- A 24-year-old male with X-linked CGD presented with concurrent cervical and hip abscesses.
- Initial cultures were non-diagnostic, and empirical antibiotic treatment failed, leading to abscess recurrence.
- Microscopic examination revealed a filamentous organism, later identified as Phellinus tropicalis.
Findings:
- Phellinus tropicalis (synonym: Inonotus tropicalis) was identified as the causative agent of recurrent abscesses in an immunocompromised CGD patient.
- This represents the third reported human case of P. tropicalis infection, exclusively in individuals with CGD.
- Antifungal treatment with voriconazole led to symptom resolution.
Implications:
- Highlights Phellinus tropicalis as a potential pathogen in CGD patients, emphasizing the need for thorough microbiological investigation.
- Underscores the importance of considering rare fungal pathogens in immunocompromised individuals with recurrent or refractory infections.
- Suggests voriconazole as an effective treatment option for Phellinus tropicalis infections in CGD.
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