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Subcutaneous pheohyphomycotic cyst from a traumatic injury: reactivation after thirty-five years
B Bellman1, F S Brandt, E G Poulos
1Department of Dermatology and Cutaneous Surgery, University of Miami School of Medicine, Coral Gables, Florida, USA.
Abstract:
Pheohyphomycoses are an uncommon diverse group of dematiaceous fungi present in soil and plant material and are potential pathogens. We report the case of a 45-year-old white Hispanic woman who presented with a hard round cyst on the dorsum of her right foot caused by a traumatic implantation of a piece of wood thirty-five years earlier. The cyst was surgically excised and the patient empirically treated with a two-month course of oral itraconazole. To our knowledge, this represents a case of the longest-lived asymptomatic pheohyphomycotic cyst in an immunocompetent person ever reported. The clinical manifestations, treatment options, and disease course are reviewed.
Insights
This case report details a rare, long-standing pheohyphomycotic cyst caused by dematiaceous fungi. The asymptomatic cyst, present for 35 years in an immunocompetent individual, was successfully treated with itraconazole.
Area of Science:
- Mycology
- Dermatology
- Infectious Diseases
Background:
- Pheohyphomycoses are infections caused by dematiaceous fungi, typically found in soil and plant matter.
- These fungi are known to be potential human pathogens, though uncommon.
- Dematiaceous fungi are characterized by dark melanin pigments in their cell walls.
Observation:
- A 45-year-old immunocompetent woman presented with a hard, round cyst on her right foot.
- The cyst resulted from a traumatic implantation of wood 35 years prior.
- The lesion was asymptomatic until presentation.
Findings:
- Surgical excision of the cyst was performed.
- The patient received a two-month empirical course of oral itraconazole post-surgery.
- Histopathological examination confirmed the presence of dematiaceous fungi, consistent with pheohyphomycosis.
Implications:
- This case represents the longest reported duration of an asymptomatic pheohyphomycotic cyst in an immunocompetent host.
- It highlights the potential for delayed presentation of fungal infections following minor trauma.
- The successful treatment underscores itraconazole as a viable therapeutic option for such rare presentations.