Purpureocillium lilacinum, formerly known as Paecilomyces lilacinus, is a filamentous fungus known for its cosmopolitan and saprophytic nature, and is frequently found in the environment. 1 As shown in an extensive review of 101 cases infected by P. lilacinum, the skin was the most common site of infection and skin infection occurs in both immunosuppressed and immunocompetent hosts. 2 In this report, we describe three patients with cutaneous hyalohyphomycosis caused by P. lilacinum and review cases caused by fungi of the genera Purpureocillium or Paecilomyces in Taiwan. | ME THODS | PatientsIn the 10 years from 2012 to 2021, three cases were diagnosed with biopsy-and fungal culture-proven P. lilacinum-related hyalohyphomycosis with profiles of drug resistance in Chang Gung Memorial Hospital. This study was approved by the Institutional Review Board of the Chang Gung Medical Foundation (IRB No. 202201432B0). The requirement for informed consent was waived.

Infective endocarditis (IE) is a serious infection and causes significant morbidity and mortality. However, the benefit of surgery for endocarditis besides antibiotic treatment in dialysis patients remains controversial. We performed a systematic review of studies published between 1960 and February 2022. Meta-analysis was conducted with a random-effects model to explore the in-hospital, 30, 60, 90, 180-d, and 1-year mortality rates in adult dialysis patients with IE. Sensitivity analysis, subgroup analysis, and meta-regression were performed to explore potential sources of heterogeneity. Confidence of evidence was evaluated by the GRADE system. Thirteen studies were included. The pooled odds ratio of in-hospital mortality was 0.62 (95% confidence interval [CI]: 0.30–1.28, p = .17), with moderate heterogeneity ( I 2 = 62%, p < .01). Three studies reported 30-d mortality, and the pooled odds ratio for surgery compared with medical treatment was even lower (0.36; 95% CI: 0.22–0.61, p < .01), with low heterogeneity ( I 2 = 0%, p = .86). With studies on fewer than 30 patients excluded, the sensitivity analysis revealed a low odds ratio of in-hospital mortality for surgery versus medical treatment (0.52; 95% CI: 0.27–0.99, p = .047), with moderate heterogeneity ( I 2 = 63%, p < .01). Subgroup analysis revealed no significant differences between any two comparator subgroups. Based on a very low strength of evidence, compared with medical treatment, surgical treatment for IE in patients on dialysis is not associated with lower in-hospital mortality. When studies on fewer than 30 patients were excluded, surgical treatment was associated with better survival.

showing the fungi in granulomatous infiltrate. Serum and bronchoalveolar lavage galactomannan analysis may be an accurate marker for diagnosing invasive aspergillosis. 5,7 Tissue detection of invasive fungal diseases with PCR to DNA sequencing 7 is a useful biomarker to their management. 7 Invasive aspergillosis has poor prognosis and should be treated preferably with voriconazole. 5,7 Possible drug interactions need caution. Azoles can increase blood concentrations of calcineurin inhibitors and mTOR inhibitors, commonly prescribed among solid organ transplant recipients (SOTR). This interaction can induce nephrotoxicity. 5 Azoles can increase levels of corticosteroids, exacerbating immunosuppression, favorable for fungal growth. The highest risk for invasive mold infections in SOTR is generally within the first year elapsed after transplant. 1,5 Immune improvement strategies should be implemented, including immunosuppressants adjustment. 5,7 Suspicious lesions in SOTR should be biopsied early and submitted to histopathology. 2 Despite early biopsy and standard treatment, this patient with hematogenic dissemination had a fatal outcome. It alerts to the disease severity, requiring closer follow-up and further scientific discussion of possible aggravators, such as skin necrosis and immunosuppressants use.