Phaeohyphomycosis caused by Exophiala jeanselmei treated with itraconazole

Cutaneous Phaeohyphomycosis of the Right Hand Caused by Exophiala jeanselmei: A Case Report and Literature Review

Exophiala spp. is increasingly reported as a pathogen causing the cutaneous, subcutaneous or invasive infection. In this report, we present a case of cutaneous phaeohyphomycosis due to E. jeanselmei on the right hand of a farmer, who suffered from this disease three years ago which had not been definitely diagnosed until he was admitted to our hospital. In our hospital, a potential fungal pathogen was observed by histopathological examination, and then was recovered and identified as E. jeanselmei by sequencing its internal transcribed spacer region. After 4 weeks of antifungal treatment, his hand recovered very well. To investigate the in vitro susceptibility of E. jeanselmei isolates to antifungal agents and compare the characteristics of their related infections among immunocompetent and immunocompromised patients, we reviewed 84 cases published in PubMed database between 1980 and 2020.

Management of a Dermocutaneous Black Mold Abscess of the Finger with Flexor Sheath Involvement

CASE

We present the case of a 76-year-old man with a black mold infection of the index finger. This granulomatous abscess uncharacteristically invaded the flexor sheath compartment, threatening proximal spread. Treatment consisted of excision of the abscess and drainage of the flexor sheath. The patient recovered unremarkably, maintaining digital function without recurrent infection.

CONCLUSION

The members of the fungal genus Exophiala are dark-pigmented mycoses commonly termed "black mold." Previously reported atraumatic black mold infections of the hand have been limited to subcutaneous involvement. To our knowledge, this is the first report of the successful treatment of a flexor sheath infection caused by the species E. jeanselmei.

Exophiala spinifera and its allies: diagnostics from morphology to DNA barcoding

Diagnostic features of morphology, physiology, serology and genetics of species belonging to the Exophiala spinifera clade (including 11 species: Exophiala oligosperma, E. spinifera, E. xenobiotica, E. jeanselmei, E. exophialae, E. nishimurae, E. bergeri, E. nigra, Rhinocladiella similis, Ramichloridium basitonum and Phaeoannellomyces elegans), comprising a large number of human-associated Exophiala species, are summarized. Several species have closely similar morphological characters and physiological profiles. Taxonomy is therefore primarily based on sequence diversity of the Internal Transcribed Spacer (ITS) region of ribosomal DNA (rDNA). Multilocus sequencing has shown that ITS is reliable for identification of the species in this clade, and is a therefore a good candidate for barcoding species of Exophiala. Species-specific fragments were searched in the ITS region of species in the Exophiala spinifera clade and can be used to design probes for diagnosis by hybridization.

A case of subcutaneous phaeohyphomycotic cyst due to Exophiala jeanselmei complicated with systemic lupus erythematosus

We report a case of subcutaneous phaeohyphomycosis by Exophiala jeanselmei that appeared on the extensor surface of the left lower leg of a 34-year-old woman with systemic lupus erythematosus (SLE). The superficial symptoms were a subcutaneous nodule 2.5 x 2 cm in size discharging a serous exudate from its center. Histopathological examination revealed granulomatous changes including large numbers of neutrophils in the dermis and the subcutaneous tissues. In addition, periodic acid-Schiff-positive fungal elements consisting of many yeast-like cells and chains of cells with hyphae were seen. The statistics on E. jeanselmei infections in Japan indicated that 54 cases (24 in men and 30 in women) had been reported, of which 50 (21 in men and 29 in women) were phaeohyphomycosis, and about half had underlying diseases; and the sites of the lesions were mainly on the extremities.

Exophiala Jeanselmei Infection in a Patient with Two Primary Malignancies

Background:

Dematiaceous fungi are emerging as an important pathogen, particularly in individuals on immunosuppressive medications. These fungi produce brown to black pigment and are responsible for a wide spectrum of diseases, including superficial infections of the skin and eye and, uncommonly, deep infections involving the central nervous system and internal organs.

Objective:

We present a male patient with localized, cutaneous Exophiala jeanselmei infection.

Methods:

We review the literature and present a brief discussion of phaeohyphomycotic infections, their clinical features, and their treatment modalities.

Results:

Workup of our patient revealed an underlying hepatic lymphoma and pulmonary squamous cell carcinoma.

Conclusions:

Phaeohyphomycotic infections, although uncommon, are increasingly recognized as important pathogens in patients who are immunologically compromised as a result of long-term steroid or other immunosuppressive therapy. Infections by these organisms in healthy-appearing individuals should prompt one to consider an immunodeficiency state and appropriate workup should be performed.

Phylogenetic analysis of ten black yeast species using nuclear small subunit rRNA gene sequences

The nuclear small subunit rRNA genes of authentic strains of the black yeasts Exophiala dermatitidis, Wangiella dermatitidis, Sarcinomyces phaemuriformis, Capronia mansonii, Nadsoniella nigra var. hesuelica, Phaeoannellomyces elegans, Phaeococcomyces exophialae, Exophiala jeanselmei var. jeanselmei and E. castellanii were amplified by PCR and directly sequenced. A putative secondary structure of the nuclear small subunit rRNA of Exophiala dermatitidis was predicted from the sequence data. Alignment with corresponding sequences from Neurospora crassa and Aureobasidium pullulans was performed and a phylogenetic tree was constructed using the neighbor-joining method. The obtained topology of the tree was confirmed by bootstrap analysis. Based upon this analysis all fungi studied formed a well-supported monophyletic group clustering as a sister group to one group of the Plectomycetes (Trichocomaceae and Onygenales). The analysis confirmed the close relationship postulated between Exophiala dermatitidis, Wangiella dermatitidis and Sarcinomyces phaeomuriformis. This monophyletic clade also contains the telemorph species Capronia mansonii thus confirming the concept of a teleomorph connection of the genus Exophiala to a member of the herpotrichiellaceae. However, Exophiala castellanii did not belong to this clade. Therefore, this species is not the anamorph of Capronia mansonii as it was postulated.