Cutaneous Fusariosis in a Patient with Job’s (Hyper-IgE) Syndrome

Abstract

Fusarium is a filamentous fungus that is ubiquitous in nature and can cause severe opportunistic infections in immunocompromised hosts. The association between Fusarium and hyper-IgE syndrome is exceedingly rare and has only been documented in a single report previously. A 44-year-old male, working as marijuana grower, with prior diagnosis of hyper-IgE syndrome and recurrent infections presented with enlarging right knee ulcer that did not respond to antimicrobial treatment. The patient was diagnosed with cutaneous fusariosis, confirmed with punch biopsy and positive wound cultures. The patient was managed with extended antifungal therapy (i.e., posaconazole) and surgical debridement resulting in remarkable improvement with wound healing leaving a pale scar. Fusarium should be considered in differential for cutaneous and invasive fungal infections in presence of cutaneous manifestations. Exposure to Cannabis plants is a noticeable risk factor. Multimodal approach involving systemic antifungals and wound debridement is essential for favorable outcome. Posaconazole was demonstrated to be a highly efficacious antifungal choice.

The Fusarium solani species complex infecting cannabis (Cannabis sativa L., marijuana) plants and a first report of Fusarium (Cylindrocarpon) lichenicola causing root and crown rot

“…The patient, who admitted to cultivating cannabis plants that were 'damaged by mold', displayed cutaneous infection on the lower right knee, suggesting a soil-borne source of inoculum, likely F. solani. This report, however, was suggestive and not confirmatory as the causal agent was not isolated in culture and identified (Altibi et al 2020). Belcher et al (2017) reported F. solani to be the cause of a similar cutaneous infection on the forearm of a patient with Job syndrome.…”

“…A majority of affected persons succumbing to infection by these Fusarium spp. have compromised immune systems or other underlying health conditions (Zhang et al 2006;Altibi et al 2020). Since the fungus can cause cutaneous infections on exposed tissues, appropriate biosecurity measures should be in place when handling coco coir (or soil) during transplanting.…”

Hyalohyphomycosis (Fusariosis): Atypical Presentation in an Immunocompetent Individual Responding to Itraconazole

“…Three forms of skin lesions have been reported so far in literature: multiple subcutaneous nodules, ecthyma gangrenosum-like lesions, and target lesions consisting of ecthyma form lesions surrounded by a thin erythematous rim,[ 6 ] with a predilection for the extremities. Fusariosis can also lead to onychomycosis and nail dystrophy in immunocompetent individuals[ 6 ] as seen in our patient. However, our patient presented with large cystic lesions, psoriasiform plaques, and palmoplantar keratoderma.…”

Fungal and mycotoxin contaminants in cannabis and hemp flowers: implications for consumer health and directions for further research

“…In a recent survey, diseases caused by Fusarium (including Fusarium head blight and Fusarium wilt) were commonly encountered during cannabis and hemp production in the United States ( Munir et al, 2023 ). This may have important implications for cannabis worker safety, as exposure to infected cannabis plants has been linked to cutaneous fusariosis ( Altibi et al, 2020 ). At present, there is a scarcity of analytical studies on Fusarium mycotoxin accumulation in cannabis and hemp inflorescences.…”