Infection of the lymphatic system by Aureobasidium pullulans in a patient with erythema nodosum leprosum

Abstract

Aureobasidium pullulans is a causal agent of phaeohyphomycosis, occasionally found in men and animals. As an agent of different opportunistic fungal processes, it may cause fungemia, systemic infections and abscesses in different viscera. This paper aims to report a case of a patient with infection of the lymphatic system by A. pullulans. A 23-year-old patient being treated for erythema nodosum leprosum presented a 60-day complaint of daily fever, hoarseness, odynophagia and weight loss. Laboratory tests showed pancytopenia with severe neutropenia, cervical adenomegaly and solid contrast uptake lesion in the oropharyngeal region. Due to neutropenia and sepsis the patient was initially treated with cefepime and vancomycin, but there was no clinical improvement. Lymph node puncture-aspiration showed yeast-form fungus identified as A. pullulans by sequencing ITS region. The patient was treated with amphotericin B deoxycholate, leading to complete recovery of bone marrow function and regression of adenomegaly and the oropharyngeal lesion.

Aureobasidium pullulans infection in a patient with chronic lymphocytic leukemia

“…aubasidani 7 . These fungi have biotechnological importance as they produce the extracellular biodegradable polysaccharide pullulan 6,7 . Among the species of fungi belonging to Aureobasidium, A. pullulans is the species most commonly recognized as an etiologic agent of human disease 2,8 .…”

“…Among the species of fungi belonging to Aureobasidium, A. pullulans is the species most commonly recognized as an etiologic agent of human disease 2,8 . Despite its limited pathogenicity, cutaneous and subcutaneous infections (i.e., phaeohyphomycoses and cromoblastomycoses), peritonitis in patients undergoing peritoneal dialysis, pulmonary mycosis, splenic and mandibular abscess, meningitis, eye infections (i.e., episcleritis and keratitis), tonsil infections, and disseminated infections have been described in the literature [1][2][3][4][5][6][8][9][10][11] . Several conditions can predispose patients to infection by fungal saprophytes, including immunosuppression, which can be due to cancer chemotherapy or organ transplantation, the broad and extensive spectrum of antimicrobial therapy, and the disruption of natural barriers, which occurs during major surgery or trauma 2,5,12 .…”

“…Antifungal drugs used for different sites of infection include amphotericin B, itraconazole, fl uconazole, ketoconazole, and fl ucytosine, and treatment can last between 4 and 8 weeks 1,2,4,6,[8][9][10] .…”

“…Its pathogenic ability in humans is becoming recognized, especially in situations of immunosuppression. However, its pathogenic mechanism remains unknown [2][3][4][5][6] .…”

ESCMID and ECMM joint clinical guidelines for the diagnosis and management of systemic phaeohyphomycosis: diseases caused by black fungi

“…Aureobasidium pullulans has an affinity for synthetic materials and surgically implanted silastic devices, as the fungus has been isolated from indwelling peritoneal dialysis catheters and central venous lines . In severely compromised patients deep infections are encountered, and the fungus has been isolated from blood, bronchoalveolar lavage, lymph nodes, splenic abscess or cerebrospinal fluid . Infections are caused mostly by traumatic inoculation of the skin or eye, and intrathecal administration of cytotoxic drugs .…”