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Osteolytic phaeohyphomycosis caused by Phialemonium obovatum
K C Magnon1, M Jalbert, A A Padhye
1Department of Pathology, Baptist Memorial Hospital System, San Antonio, Tex.
Abstract:
Phialemonium obovatum was found to be the cause of nosocomial osteomyelitis in a 41-year-old man after sustaining a nonpenetrating injury to his lumbar and cervical region. Histologic examination of fragments of disk and bone from L3-4 hemilaminectomy showed multiple fragments of fibrocartilage with focal necrosis, chronic inflammation, and granulation tissue formation. Sections stained with Gomori's methenamine silver procedure showed multiple fungal elements in necrotic areas consisting of irregularly branched, hyaline septate hyphae having swollen cells, and occasional yeastlike cells. The use of Fontana-Masson silver stain showed the presence of melanin in cells walls and septa of the hyphae. Phialemonium obovatum was isolated when the ground tissue from disk and bone from L3-4 was cultured on biphasic brain-heart infusion medium. Colonies were moist, off-white to ochraceous with a characteristic green, diffusible pigment on the reverse side. The isolate grew well up to 40 degrees C. It formed characteristic adelophialides without conspicuous collarettes and basal septa and produced smooth, one-celled, hyaline, and obovate conidia.
Insights
Phialemonium obovatum caused a rare case of osteomyelitis in a patient with a spinal injury. Fungal elements with melanin were identified in bone and disk tissue, confirming the infection.
Area of Science:
- Mycology
- Infectious Diseases
- Orthopedics
Background:
- Nosocomial infections can arise from various pathogens, including fungi.
- Osteomyelitis, an infection of the bone, can be challenging to diagnose and treat.
- Spinal injuries can create opportunities for opportunistic infections.
Observation:
- A 41-year-old male developed nosocomial osteomyelitis following a nonpenetrating spinal injury.
- Histological examination revealed fungal elements in necrotic bone and disk tissue.
- Melanin was detected in the cell walls and septa of the fungal hyphae.
Findings:
- Phialemonium obovatum was identified as the causative agent of osteomyelitis.
- The fungus was isolated from lumbar disk and bone tissue.
- Microscopic analysis showed characteristic hyphae, yeast-like cells, and melanin.
- Culture revealed specific colony morphology and growth characteristics up to 40°C.
Implications:
- This case highlights Phialemonium obovatum as a potential cause of deep-seated fungal infections.
- Early identification and targeted antifungal therapy are crucial for managing such infections.
- Understanding the pathogenesis of fungal osteomyelitis is essential for improving patient outcomes.