A case of cutaneous protothecosis successfully treated with local thermal therapy as an adjunct to itraconazole therapy in an immunocompromised host

Abstract

We report a case of human protothecosis in an immunocompromised host which was caused by Prototheca wickerhamii and was successfully treated with thermal adjunct therapy combined with systemic itraconazole therapy. A 78-year-old man taking 30 mg prednisolone daily had a 1-week history of erythematous plaques on the dorsal aspect of his right hand and forearm after sustaining a small traumatic injury. Histopathology of the lesions revealed granulomatous inflammatory changes with numerous microorganisms that had multiple septations in their cytoplasm. On the basis of mycological features and the results of the sugar assimilation test, the etiologic agent was identified as Prototheca wickerhamii. Although the lesion showed no response to the systemic itraconazole therapy and topical ketoconazole treatment, a complete resolution was achieved by the use of thermal therapy as an adjunct to systemic itraconazole.

Prototheca miyajii sp. nov., isolated from a patient with systemic protothecosis

“…Incidentally, we also determined the rDNA sequences of IFM 54820, the strain isolated from a cutaneous protothecosis patient in Japan (Yamada et al, 2010). This strain was originally designated P. wickerhamii (Yamada et al, 2010) and has been deposited as Prototheca sp. at the Medical Mycology Research Centre, Chiba University.…”

Successful Treatment of Protothecal Tenosynovitis in an Immunocompetent Patient using Amphotericin B Deoxycholate

“…Infection may occur by penetration of the organism when the injured skin comes in contact with contaminated water [ 1 ]. Protothecal infections mainly develop in patients with underlying immunosuppression or severe underlying disease such as local or systemic steroid use, hematologic malignancy, diabetes mellitus, acquired immunodeficiency syndrome, organ transplantation, alcoholism, and peritoneal dialysis [ 7 ]. Protothecosis has also been reported in association with surgery and orthopedic procedures in a hospital setting.…”

“…Thus, in vitro antifungal susceptibility testing is not routinely recommended for patient management. Antifungals such as the azoles (ketoconazole, itraconazole, fluconazole) and polyenes (conventional amphotericin B, liposomal amphotericin B) appear to be the most effective medical treatment to date [ 4 , 7 ]. Nevertheless, in vitro antifungal susceptibility testing was performed because intravenous administration of fluconazole was not successful in this patient.…”

Cutaneous Protothecosis in a Patient with Chronic Lymphocytic Leukemia: A Case Report and Literature Review

“…There is a single report of the successful use of caspofungin in the literature [ 33 ]. Successful use of local thermotherapy (heat) as an adjunct to itraconazole therapy has also been reported [ 34 ]. More recently, a newer antifungal agent, voriconazole, has become another potential option for the treatment of cutaneous protothecosis, as it has fewer potential hepatotoxic side effects than several of the other azole agents [ 23 ].…”