Cutaneous Phaeohyphomycosis Presenting as a Progressive Disfiguring Lesion of the Face in an Immunocompetent Individual; A Rare Occurrence

Chemotherapy Extravasation Causing Soft-Tissue Necrosis Mimicking Infection: A Longitudinal Case Study

Extravasation injuries are uncommon, underreported, and often misdiagnosed in patients. The signs and symptoms of extravasation injuries vary from simple pain and tenderness to tissue necrosis and potentially fatal secondary infections. Extravasation may progress to more severe conditions such as necrotizing fasciitis (NF) or cellulitis, so special care is needed by physicians to identify and treat these injuries correctly. Here, we explore a case study on extravasation injuries mimicking NF leading to infectious complications and discuss the proper diagnosis and treatment of extravasation injuries as well as other NF-mimicking diseases. We present a case of a 44-year-old Hispanic male with a history of B-cell acute lymphoblastic leukemia who underwent inpatient chemotherapy treatment via a chest port.

Trauma-Induced Phaeohyphomycosis in an Immunocompetent Host on Dupilumab

Phaeohyphomycosis is a rare infection caused by dematiaceous fungi containing melanin in their cell wall. Patients are often immunocompromised, and cases seen in immunocompromised hosts have increased in recent years. Dupilumab, a monoclonal antibody against interleukin-4 (IL-4) and interleukin-13 (IL-13) used for the treatment of atopic dermatitis, has been linked to hypersensitivity reactions resulting in facial redness, and there is growing evidence that dupilumab may increase susceptibility to yeast infections as well. We present a case of trauma-induced cutaneous phaeohyphomycosis in an immunocompetent host on dupilumab. As dupilumab becomes more commonly encountered in practice, this case is meant to explore the potential relationship between dupilumab and predisposition to opportunistic fungal infections.

Case Report: Plantar Cyst Caused by Phaeoacremonium inflatipes in an Immunocompetent Male, Resolving with Combination Potassium Iodide and Itraconazole Therapy

Phaeohyphomycosis is a subcutaneous mycosis presenting as verrucous or ulcerated plaques/nodules/cysts. We report here, a case of cystic plantar phaeohyphomycosis in a 72-year-old immunocompetent man. On examination, an asymptomatic, skin colored, firm-to-soft, fluctuant, cystic lesion was seen over the left forefoot. Aspirate of lesion yielded velvety grayish-brown colonies on fungal culture, with septate, branched, phaeoid hyphae with lateral and terminal conidiophore noted on microscopic examination, and identified as Phaeoacremonium inflatipes. Due to the ongoing pandemic and advanced age, the patient declined surgical intervention and we started him on a supersaturated solution of potassium iodide (SSKI) (starting at 5 drops thrice a day and gradually increasing 1 drop per day to 20 drops thrice a day) and itraconazole (100 mg twice daily) in combination. An encouraging response was seen at 6 weeks, with complete resolution at 6 months follow-up. We report this case for the unusual fungus isolated (i.e., P. inflatipes) as well as a robust response to a combination of SSKI and itraconazole. In cases where patients refuse or are unfit for surgical excision, this combination maybe an effective therapeutic alternative.

Novel cases of cutaneous phaeohyphomycosis by Alternaria alstromeriae, Epicoccum tritici and Phialemonium obovatum from North India

BACKGROUND

A growing number of non-dermatophytic moulds and yeasts with the ability to act as human pathogens are reported every year. Dematiaceous fungi cause phaeohyphomycosis which encompasses a broad spectrum of diseases ranging from superficial (cutaneous and subcutaneous) to disseminated infections. Such fungal infections are responsible for causing significant morbidity and mortality, frequently in immunocompromised patients and rarely in immunocompetent patients.

OBJECTIVES

To investigate the prevalence of cutaneous mycosis in Jammu district (India) and to isolate and identify the recovered causal agents from the affected skin of the patients.

METHODS

For direct microscopy, 10% KOH was used. Skin samples were collected carefully from the affected areas of suspected patients, followed by the isolation and identification of the causal agents by cultural examination, morphological examination and ITS sequencing.

RESULTS

Herein, we report and describe three new cases of cutaneous phaeohyphomycosis from District Jammu of Union Territory Jammu and Kashmir, India. The age of the patients under study ranged from 17 to 42 years and the duration of infection from 1 to 2 years. The etiological agents that were recovered from the patients under study were Alternaria alstromeriae, Epicoccum tritici and Phialemonium obovatum. These dematiaceous fungal species were isolated from the skin specimen of immunocompetent hosts.

CONCLUSION

Among the three isolated etiological agents, two (Alternaria alstromeriae, Epicoccum tritici) represent new global records and one (Phialemonium obovatum) new record to India as causal agents of cutaneous phaeohyphomycosis. Careful microscopic and mycological examination form the basis of correct diagnosis of such fungal infections in the absence of simple and reliable laboratory tests (serologic or antigen tests).