Disseminated Exophiala dermatitidis causing septic arthritis and osteomyelitis

Abstract

BackgroundExophiala dermatitidis is a melanized fungus isolated from many environmental sources. Infections caused by Exophiala species are typically seen in immunocompromised hosts and manifest most commonly as cutaneous or subcutaneous disease. Systemic infections are exceedingly rare and associated with significant morbidity and mortalityCase presentationA 28-year-old female originally from India presented with fevers, chills, weight loss and increasing back pain. She had a recent diffuse maculopapular rash that resulted in skin biopsy and a tentative diagnosis of sarcoidosis, leading to administration of azathioprine and prednisone. An MRI of her spine revealed a large paraspinal abscess requiring surgical intervention and hardware placement. Cultures from the paraspinal abscess grew a colony of dark pigmented mold. Microscopy of the culture revealed a melanized fungus, identified as Exophiala dermatitidis. Voriconazole was initially utilized, but due to relapse of infection involving the right iliac crest and left proximal humerus, she received a prolonged course of amphotericin B and posaconazole in combination and required 7 separate surgical interventions. Prolonged disease stability following discontinuation of therapy was achieved.ConclusionsDescribed is the first identified case of disseminated Exophiala dermatitidis causing osteomyelitis and septic arthritis in a patient on immunosuppressive therapy. A positive outcome was achieved through aggressive surgical intervention and prolonged treatment with broad-spectrum antifungal agents.

Neurotropic black yeast Exophiala dermatitidis in children’s gut microbiota

“…4,8,11,19 Patient with DM1 diagnosis had a high CFU/mL (2x104) suggesting that may be related to the inherited innate immune disorders. 3,6,7,19 Strains were isolated consecutively during a period of 3 weeks, supporting what de Hoog already proposed that E. dermatitidis is able to persist in gut for prolonged periods instead of being a transitory microbiota, 12 however, the clinical significance of the gastrointestinal carriage is still unknown.…”

“…5 This specie seems to have neurotropism, with significant morbidity and mortality. 6,7 It has also been isolated from a wide range of surfaces such as soil, glacier water, bathrooms, dishwashers, steam baths, contaminated areas with aromatic hydrocarbons, indoor habitats connected to water sources and high temperatures. [8][9][10][11] In the human intestinal tract there are only a few reports from Germany, Nigeria, Netherlands, Slovenia and United States.…”

Exophiala dermatitidis: Key issues of an opportunistic fungal pathogen

“…Immunosuppressed and elderly patients suffer from infections with E. dermatitidis most commonly in the form of phaeohyphomycosis, keratitis or chromoblastomycosis; 54 cases of phaeohyphomycosis have been described between 1934 and 2006 (Figure 2) [12,13]. Literature research on recent published case reports involving E. dermatitidis-caused infections revealed 20 new cases since 2007 in both, immunocompetent and -suppressed patients (Table 1) [21,[36][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51]. E. dermatitidis may also be a severe agent of pneumonia [12].…”

The Neurotropic Black Yeast Exophiala dermatitidis Induces Neurocytotoxicity in Neuroblastoma Cells and Progressive Cell Death

“…Occasionally, it can cause mildly invasive systemic infections that are associated with significant morbidity and mortality. Typical infections are seen in immunocompromised hosts such as transplant recipients, oncology, and pediatric patients, where it manifests itself as a subcutaneous disease and rarely as deep mycoses [9,[22][23][24][25][26]. Particularly in East Asia, E. dermatitidis was detected in disseminated and neurotropic infections with high mortality [11,27].…”