Chronic Kirschsteiniothelia infection superimposed on a pre-existing non-infectious bursitis of the ankle: the first case report of human infection

Abstract

BackgroundKirschsteiniothelia is a saprophytic fungus that is abundantly present in the environment. To date, there have been no reports of human infection caused by this fungus. We report a case of Kirschsteiniothelia infection superimposed on a pre-existing non-infectious bursitis of the ankle.Case presentationAn 81-year-old immunocompetent female local farmer noticed the presence of a nodule on her right ankle 5 years before her first visit to our hospital. A cystic mass of approximately 45 mm × 30 mm was present at the tip of the right lateral malleolus. Culture of the aspirated fluid revealed visibly black colonies and characteristic blackish hyphae; nucleotide sequence of the internal transcribed spacer region was determined and compared in a GenBank database. The results indicated Kirschsteiniothelia infection.ConclusionsWe described the first case of Kirschsteiniothelia infection manifested as ankle bursitis. The disease seemed to be localized and systemic antibiotics had not been used in this case. However, continued observation is needed because of the possibility of disease progression with the pathogen.Electronic supplementary materialThe online version of this article (10.1186/s12879-018-3152-3) contains supplementary material, which is available to authorized users.

Chromoblastomycosis Due to a Never-before-Seen Dematiaceous Fungus in a Kidney Transplant Patient

“…Several unexpected agents, such as Aureobasidium pullulans, Rhytidhysteron spp., Chaetomium funicola, and Catenulostroma chromoblastomycosum, have been previously shown to be responsible for chromoblastomycosis-like skin lesions, albeit with no evidence of muriform cells in most cases [6]. Interestingly, Nishi et al recently reported the first human infection due to a phenotypically similar mold, identified as the Kirschsteiniothelia species, in a Japanese patient presenting with infectious ankle bursitis [7] with no clinical presentation of chromoblastomycosis. Although phenotypically similar, the isolate analyzed in our study shares less than 90% DNA similarity with their strain, suggesting that it is a species that has never been described.…”

“…A Kirschsteiniothelia spp. isolate was tested by Nishi et al and showed a high minimal inhibitory concentration (MIC) against most of the usual antifungals, such as triazoles (>8 µg/mL for itraconazole and voriconazole), amphotericin B (>16 µg/mL), and echinocandins (0.5 µg/mL and 4 µg/mL, for micafungin and caspofungin, respectively) [7]. By contrast, the MIC against 5-fluorocytosin, which can be combined with azoles, was low (0.12 µg/mL).…”