Facial Phaeohyphomycosis in an Immunocompetent Individual: A Rare Presentation of a Rare Fungus

Abstract

Phaeohyphomycosis is a rare mycotic infection caused by heterogenous groups of dematiaceous fungi involving the skin and subcutaneous tissue. Here, we report a case of cutaneous phaeohyphomycosis presenting as cauliflower-like verrucous lesion over the face in an immunocompetent individual. Histopathology showed suppurative granulomatous inflammation replete with pigmented broad fungal hyphae which is stained with periodic acid–Schiff stain, Grocott's methanamine silver stain, Schmorl's stain, and Masson-Fontana stain. Culture showed black-colored colonies identified as Exophiala spinifera.

Novel cases of cutaneous phaeohyphomycosis by Alternaria alstromeriae, Epicoccum tritici and Phialemonium obovatum from North India

“…In the recent decade, an upsurge in the incidence rate of rarely encountered dematiaceous fungal agents causing opportunistic infections has been observed. Several case reports of cutaneous phaeohyphomycosis caused by various dematiaceous fungi, such as Exophiala , Curvularia , Cladosporium , Alternaria and Fonsecaea have been reported from India and some other countries 9,11,32–37 . Similar to our results, a case of cutaneous phaeohyphomycosis of foot web by Curvularia lunata in a 31‐year‐old immunocompetent male has been reported 38 .…”

“…Several case reports of cutaneous phaeohyphomycosis caused by various dematiaceous fungi, such as Exophiala, Curvularia, Cladosporium, Alternaria and Fonsecaea have been reported from India and some other countries. 9,11,[32][33][34][35][36][37] Similar to our results, a case of cutaneous phaeohyphomycosis of foot web by Curvularia lunata in a 31-year-old immunocompetent male has been reported. 38 Another recent case study from Brazil reported Exophiala xenobiotica as an etiological agent of cutaneous phaeohyphomycosis in a 45 years old man.…”

“…Also, individuals with immunocompromised status due to underlying diabetes, novel medical therapy (such as monoclonal antibodies), organ transplantation, use of corticosteroid, chemotherapy and HIV infection are likely to be more susceptible to the life‐threatening infections by dematiaceous fungi 9,10 . However, few cases of similar infections have been reported even in immunocompetent individuals 11,12 . These infections have been reported to be common in males than females probably because of their outdoor occupation 10,13,14 .…”

“…9,10 However, few cases of similar infections have been reported even in immunocompetent individuals. 11,12 These infections have been reported to be common in males than females probably because of their outdoor occupation. 10,13,14 However, there are few exclusive reports of dematiaceous fungi capable of causing infections in children as well.…”

Subcutaneous Cyst Due to a Novel Fungus, Aquastroma magniostiolata: A Case Report

“…Various dematiaceous fungi have been reported from phaeohyphomycotic cysts. Various unusual fungal agents such as Phialemoniopsis ocularis [10], Phaeoacremonium inflatipes [11], Exophiala oligosperma [12], Exophiala spinifera [13], Medicopsis romeroi (Pyrenochaeta romeroi) [14,15] are the reported from of subcutaneous phaeohyphomycosis.…”