Phaeohyphomycosis and nocardiosis of the skin are uncommon infections caused by phaeoid (dark-pigmented) fungi and Nocardia, respectively. We report an unusual case of concurrent infections with these pathogens. An 85-year-old Japanese woman visited our outpatient clinic complaining of an erythematous plaque with comedo on her left forearm and multiple nodules and abscesses over the right middle finger and the dorsum of her right hand. One month prior to her visit, she had experienced insect bites on her right middle finger and left forearm during her work on a farm. She had been (and still is) receiving prednisolone (10 mg/day) and azathioprine (5 mg/day) for idiopathic thrombocytopenic purpura. A biopsy specimen from the skin lesion of her left forearm revealed a granulomatous inflammation in the dermis with slightly pigmented hyphae, which were positive for Fontana Masson staining. Exophiala spinifera was isolated from the biopsied tissue and the crust of the lesion. A dense and diffuse inflammatory infiltrate with abscess formation in the dermis was observed in the biopsy specimen from the right hand. Gram’s staining revealed the presence of branching filaments in this tissue. Nocardia asteroides was isolated from the biopsied tissue. A diagnosis of double infections with phaeohyphomycosis and nocardiosis of the skin was established by these findings. Antimicrobial treatment with oral itraconazole (200 mg/day) and minocycline (100-200 mg/day) led to a clinical resolution within 5 months. This is the first documented case to our knowledge of concurrent infections with phaeohyphomycosis and cutaneous nocardiosis in humans.
Full conference title:
The 15 th Congress of the International Society for Human and Animal Mycology
- ISHAM 15th (2003)