Phialophora richardsiae infection in humans

Phialophora richardsiae infection in humans is rare. The first human isolate was recovered from a patient with a phaeomycotic cyst in 1968. Since 1975 seven other cases have appeared in the world literature, and an additional case is reported here. The mean age of these nine patients was 61.4 years. Two patients had diabetes mellitus, one had diabetes mellitus and disseminated adrenocortical carcinoma, and one had a myeloproliferative disorder. The mode of acquisition was presumed to be inoculation with contaminated plant material, but a history consistent with an inoculation injury was obtained in only four patients and a retained splinter was found in the lesion of only one patient. Infection with P. richardsiae was not associated with systemic symptoms or signs. Six patients presented with a single subcutaneous cystic granulomatous lesion. One patient had chronic dacryocystitis. More extensive or invasive disease occurred in two patients, both with an ultimately fatal underlying neoplastic process. A specific etiologic diagnosis was made by culture of purulent material obtained by excisional biopsy in six patients, incision and drainage in one patient, aspiration in one, and spontaneous drainage in one. Subcutaneous nodules were cured with surgical excision. There is insufficient information concerning antifungal therapy to recommend its use.