Subcutaneous phaeohyphomycosis caused by Bipolaris hawaiiensis. A case report

Cutaneous Bipolaris Infection in a Neutropenic Patient with Acute Lymphoblastic Leukemia

Bipolaris spicifera is a darkly pigmented (dematiaceous) fungus that uncommonly causes infections in humans. There are few cases of reported cutaneous Bipolaris infection in the literature. We report a case of a five-year-old boy with B-precursor-cell acute lymphoblastic leukemia who developed a cutaneous fungal infection on his left cheek Histopathological and microbiological findings identified the fungus as Bipolaris spicifera. Surgical excision and systemic antifungal therapy are the mainstay of treatment.

Unilateral renal phaeohyphomycosis due to Bipolaris spicifera in an immunocompetent child - rare case presentation and review of literature

Phaeohyphomycosis refers to infections caused by phaeoid fungi that can have an aggressive course in normal hosts. We report a case of left-sided renal phaeohyphomycosis due to Bipolaris spicifera in a 7-year-old immunocompetent male child. He presented with fever, dysuria, nausea, vomiting and flank pain. Examination revealed tenderness at the left costovertebral angle. Histological examination and culture of biopsy from left kidney and blood yielded the fungal pathogen Bipolaris spicifera. His past history revealed that he was diagnosed perinatally with bilateral hydronephrosis due to bilateral pelvic ureteric junction obstruction. He underwent an open dismembered pyeloplasty on the left side followed by the right side pyeloplasty at the age of 6 months and 1.5 years respectively. He was on a regular follow-up for 5 years and had been doing well. Now he was diagnosed as a case of unilateral renal phaeohyphomycosis. The patient was managed successfully with antifungal drugs amphotericin B and itraconazole. A review of previously reported bipolaris cases with their clinical manifestations, treatment and outcome is presented. Renal phaeohyphomycosis remains an unusual disease. Aggressive diagnostic approaches and careful management helped in survival of the patient.

Cochliobolus hawaiiensis Sinusitis, a Tropical Disease? A Case Report and Review of the Literature

A sinusitis caused by Cochliobolus hawaiiensis (anamorph: Bipolaris hawaiiensis) was diagnosed in metropolitan France in a patient originating from New Caledonia. The patient completely recovered after surgical treatment consisting in marsupialization of the mucoceles and removal of the fungus balls located in the left nasal cavity and the left maxilla and ethmoid sinuses. One year after, both endoscopic examination and CT scan of the sinuses were normal. Various clinical presentations of diseases associated with C. hawaiiensis have been reported. A review of the literature indicates that although C. hawaiiensis is very rarely reported in Europe, it is one of the major rhinosinusitis agents in areas with a relatively warmer climate, such as India or Southwestern USA. This is the first report of a sinusitis caused by C. hawaiiensis diagnosed in France, with a total recovery outcome.

Bipolaris hawaiiensis as an emerging cause of cutaneous phaeohyphomycosis in an Antillean manatee Trichechus manatus manatus

Phaeohyphomycoses are emerging and opportunistic diseases caused by dematiaceous fungi that infect many animal species. This paper describes a case of cutaneous phaeohyphomycosis in an Antillean manatee Trichechus manatus manatus caused by Bipolaris hawaiiensis. Blackish skin lesions were observed in an Antillean manatee calf held captive in Brazil. Direct examination of skin scraping from the affected areas revealed the presence of dematious hyphae. Culture of skin fragments led to the isolation and subsequent identification of B. hawaiiensis as the etiologic agent. Treatment with itraconazole for 14 d was effective. Infections by Bipolaris spp. are rare in animals, and this is the first report of B. hawaiiensis in veterinary medicine.

Subcutaneous phaeohyphomycosis caused by Cladophialophora sp.: a case report

A case of subcutaneous phaeohyphomycosis caused by Cladophialophora sp. is reported. The patient, an immunosuppressed host presented a nodule on the dorsum of the right hand which relapsed four months after excision. Dematiaceous septate hyphal and yeast like elements were seen in mycological and histological examination. The isolated fungus was identified on the basis of micro-macromorphological and physiologic characteristics.

Pyoderma gangrenosum with a contiguous erosion of the distal ulna

BACKGROUND

Pyoderma gangrenosum (PG) has been described in association with sterile neutrophilic infiltration of several organ systems, including the skeleton. The most frequent cause of bony disease in PG has been chronic, recurrent, multifocal osteomyelitis, a sterile inflammatory disease of children and young adults mimicking infectious osteomyelitis. Bony erosions have been only rarely described in direct contiguity to a PG ulcer.

OBJECTIVE

We report a 53-year-old woman with recurrent PG who developed an erosion of the distal ulna adjacent to a PG ulcer. The patient responded to high-dose prednisone, and a repeat radiograph of the wrist four months later was normal.

CONCLUSION

This case demonstrates another example of cortical osteolysis directly adjacent to a PG ulcer in which the bony changes may be neutrophil-induced.

[Subcutaneous phaeohyphomycosis in the state of Pará: a report of 3 cases]

Three cases of subcutaneous phaeohyphomycosis from the state of Pará, Brazil are reported. This is the first time that this form of phaeohyphomycosis is described in northern Brazil. The etiologic agents could not isolated, and the diagnosis in all cases was established only on histopathological basis, particularly through the demonstration of fungal elements in tissue sections. Hyphal fragments and vesicular cells were very numerous and conspicuous in special (Grocott and Fontana-Masson methods) stained sections, in contrast to their apparent scarcity in routine hematoxilin-eosin preparations. The difference was certainly due to the aspect in the latter of the invasive tissue forms: the thin-walled and light brown pigmented organisms stained poorly and were very difficult to distinguish from the tissue components.

Feo-hifomicose subcutânea por Exophiala jeanselmei: registro de três casos em transplantados renais

São registrados três casos de feo-hifornicose subcutânea em transplantados renais provocados pela Exophiala jeanselmei (Langeron) McGinnis et Padhye 1977, fungo demácio capaz, também, de produzir raramente eumicetoma de grãos pretos. Este fungo, segundo KWON-CHUNG & BENNETT, 1992(27) é antigenicamente muito heterogêneo, sendo identificados até o presente momento três sorotipos com subgrupos dentro de cada um deles. A feo-hifomicose subcutânea vem se tornando cada vez mais freqüente em transplantados renais, submetidos a terapêutica imunodepressora. Como a Exophiala jeanselmei já foi isolada do meio ambiente, torna-se dificil explicar a patogenia desses casos por um despertar ou reativação de processos quiescentes. Os Autores fizeram ampla revisão da literatura, registrando principalmente os casos de feo-hifomicose publicados no Brasil. Sugerem também, eventual ação fungistática da ciclosporina A sobre a Exophiala jeanselmei.