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Recurrent Scedosporium apiospermum mycetoma successfully treated by surgical excision and terbinafine treatment: a case report and review of the literature

View Article: PubMed Central - PubMed

ABSTRACT

Background: Scedosporium apiospermum is an emerging opportunistic filamentous fungus, which is notorious for its high levels of antifungal-resistance. It is able to cause localized cutaneous or subcutaneous infections in both immunocompromised and immunocompetent persons, pulmonary infections in patients with predisposing pulmonary diseases and invasive mycoses in immunocompromised patients. Subcutaneous infections caused by this fungus frequently show chronic mycetomatous manifestation.

Case report: We report the case of a 70-year-old immunocompromised man, who developed a fungal mycetomatous infection on his right leg. There was no history of trauma; the aetiological agent was identified by microscopic examination and ITS sequencing. This is the second reported case of S. apiospermum subcutaneous infections in Hungary, which was successfully treated by surgical excision and terbinafine treatment. After 7 months, the patient remained asymptomatic. Considering the antifungal susceptibility and increasing incidence of the fungus, Scedosporium related subcutaneous infections reported in the past quarter of century in European countries were also reviewed.

Conclusions: Corticosteroid treatment represents a serious risk factor of S. apiospermum infections, especially if the patient get in touch with manure-enriched or polluted soil or water. Such infections have emerged several times in European countries in the past decades. The presented data suggest that besides the commonly applied voriconazole, terbinafine may be an alternative for the therapy of mycetomatous Scedosporium infections.

No MeSH data available.


Related in: MedlinePlus

Edema, erythema and small superficial abscesses (white arrows) on the lower right leg and foot
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Fig1: Edema, erythema and small superficial abscesses (white arrows) on the lower right leg and foot

Mentions: After 2 weeks, however, the patient was referred to our clinic, owing to the progression in his cutaneous symptoms. The patient then presented with a severely oedemic and painful lower right leg, with slight erythema and multiple small soft papules (Fig. 1). In addition, the whole skin of this extremity had a sponge-like feel to the touch. No notable symptoms were present on the left leg. Laboratory tests showed elevated CRP (38 mg/L) and high white blood cell count (12.85 × 109/L). Ultrasound revealed four 10–13 mm-sized subcutaneous collections of echogenic fluid in the right leg. After incision and drainage of these lesions, swabs were sent to the microbiological laboratory for culturing. Only Scedosporium apiospermum grew in culture after 3 days of incubation at normal atmosphere at 30 °C. After accurate morphological assessment, the sample was sent for additional identification by DNA sequencing.Fig. 1


Recurrent Scedosporium apiospermum mycetoma successfully treated by surgical excision and terbinafine treatment: a case report and review of the literature
Edema, erythema and small superficial abscesses (white arrows) on the lower right leg and foot
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC5391591&req=5

Fig1: Edema, erythema and small superficial abscesses (white arrows) on the lower right leg and foot
Mentions: After 2 weeks, however, the patient was referred to our clinic, owing to the progression in his cutaneous symptoms. The patient then presented with a severely oedemic and painful lower right leg, with slight erythema and multiple small soft papules (Fig. 1). In addition, the whole skin of this extremity had a sponge-like feel to the touch. No notable symptoms were present on the left leg. Laboratory tests showed elevated CRP (38 mg/L) and high white blood cell count (12.85 × 109/L). Ultrasound revealed four 10–13 mm-sized subcutaneous collections of echogenic fluid in the right leg. After incision and drainage of these lesions, swabs were sent to the microbiological laboratory for culturing. Only Scedosporium apiospermum grew in culture after 3 days of incubation at normal atmosphere at 30 °C. After accurate morphological assessment, the sample was sent for additional identification by DNA sequencing.Fig. 1

View Article: PubMed Central - PubMed

ABSTRACT

Background: Scedosporium apiospermum is an emerging opportunistic filamentous fungus, which is notorious for its high levels of antifungal-resistance. It is able to cause localized cutaneous or subcutaneous infections in both immunocompromised and immunocompetent persons, pulmonary infections in patients with predisposing pulmonary diseases and invasive mycoses in immunocompromised patients. Subcutaneous infections caused by this fungus frequently show chronic mycetomatous manifestation.

Case report: We report the case of a 70-year-old immunocompromised man, who developed a fungal mycetomatous infection on his right leg. There was no history of trauma; the aetiological agent was identified by microscopic examination and ITS sequencing. This is the second reported case of S. apiospermum subcutaneous infections in Hungary, which was successfully treated by surgical excision and terbinafine treatment. After 7 months, the patient remained asymptomatic. Considering the antifungal susceptibility and increasing incidence of the fungus, Scedosporium related subcutaneous infections reported in the past quarter of century in European countries were also reviewed.

Conclusions: Corticosteroid treatment represents a serious risk factor of S. apiospermum infections, especially if the patient get in touch with manure-enriched or polluted soil or water. Such infections have emerged several times in European countries in the past decades. The presented data suggest that besides the commonly applied voriconazole, terbinafine may be an alternative for the therapy of mycetomatous Scedosporium infections.

No MeSH data available.


Related in: MedlinePlus