Cutaneous Hyalohyphomycosis Caused by Paecilomyces lilacinus in an Immunocompetent Host Successfully Treated with Itraconazole: Case Report and Review

Abstract

Paecilomyces lilacinus is an emerging fungal pathogen that is highly resistant to many antifungal drugs. Skin and subcutaneous soft tissue infections caused by this organism are very unusual. Most cases occur in patients with impaired host defenses or following surgical procedures. There has been only one previous report of a histologically confirmed cutaneous infection due to Paecilomyces lilacinus in a patient without predisposing factors. Described here is the second histopathologically proven case of Paecilomyces lilacinus cutaneous infection in a healthy patient without any apparent portal of entry. Prolonged antifungal chemotherapy with itraconazole led to resolution of the skin lesion. This case of sporadic cutaneous infection due to Paecilomyces lilacinus is believed to be the first reported in Europe and the first histopathologically proven case successfully treated with itraconazole.

An Unusual Presentation of Aspergillus Species in a Routine Cervicovaginal Pap Smear

“…5 However, certain fungi causing vaginitis also have been encountered in immunocompetent hosts. 6,7 Fruiting bodies are very important in identification of a particular fungus and its species, depending on the length and width of conidiophores, shape of vesicles and the chains of conidia. In the present case, all of the above factors strongly suggested that the fungus present in the Pap smear was a contaminant and the probable species was Aspergillus fumigatus.…”

Efficacy of voriconazole in a murine model of invasive paecilomycosis

“…The most frequent clinical manifestations are oculomycosis and cutaneous and subcutaneous infections [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19]. Less frequently, however, this fungus can also disseminate, probably due to this ability to sporulate in tissue, producing numerous conidia that spread haematogenously [1,20].…”

Acute oral intragastric pathogenicity and toxicity in mice of Paecilomyces fumosoroseus isolated from whiteflies

“…Fungal infections in mammals (Whitney et al 1984) by P. fumosoroseus, and in humans caused by Paecilomyces species are very rare and may develop in patients with impaired host defenses or following foreign body implants (Naudi and Singh 1992;Alimdzhanova 1993;Itin et al 1998;Gutie´rrez-Rodero et al 1999;Ranjan-Nayak et al 2000). Opportunistic Paecilomyces species may occur as in some fungi belonging to the entomophthoralean group.…”