Phaeohyphomycosis Due to Exophiala jeanselmei: An Emerging Pathogen in India—Case Report and Review

Abstract

We present a rare case of a 30-year-old woman who presented with a swelling on the lateral aspect of her left forearm, present since 6 months, adjacent to a 16-year-old burn scar. X-ray of elbow joint and forearm revealed the subcutaneous nature of the swelling. Giemsa and periodic acid-Schiff-stained smears and potassium hydroxide mount of fine-needle aspirate of the swelling revealed dematiaceous, branching, and septate fungal hyphae. Fungal culture of the aspirated pus showed growth of Exophiala jeanselmei. Histopathological examination revealed brown-coloured hyphae with foreign body giant cell reaction and palisading granulomas in the surrounding tissue. The patient was successfully treated with surgical excision of the swelling. All the cases of phaeohyphomycosis due to Exophiala spp. in India are also reviewed.

Phaeohyphomycosis due to Exophiala infections in solid organ transplant recipients: Case report and literature review

“…Dissemination can occur, and may involve the central nervous system (CNS). One hypothesis is that melanin acts as a scavenger for free radicals and hypochlorite generated by phagocytic cells, thereby facilitating a protracted and rarely disseminated disease …”

“…Phaeohyphomycosis has been thought to be more prevalent in tropical countries because of increased occupational exposure; however, cases are rising in industrialized countries owing to the increased prevalence of immunocompromised patients. Among the immunocompromised patients affected, the majority of cases have occurred in solid organ transplant patients, followed by those with autoimmune disease, malignancy, and human immunodeficiency virus infection …”

Subcutaneous Phaeohyphomycosis Cyst Associated with Medicopsis romeroi in an Immunocompromised Host

“…Most phaeohyphomycosis infections are caused by Exophiala , Alternaria, Cladophialophora , Phialophora or Curvularia / Bipolaris species; however, many others have been implicated on occasion [5, 7]. Infection is most often acquired from traumatic implantation of the causative agent into subcutaneous tissue.…”

“…It commonly presents as a single, well-encapsulated, subcutaneous mass or a nodule at the site of previous trauma, commonly on the extremities. The common causative organisms reported include Exophiala , Alternaria , Phialophora , Cladophialophora , and Curvularia/Bipolaris species [5, 7]; however, many others have been implicated on occasion [8, 9]. …”

The Curious Case of “Case Report” of Infections Caused by Human and Animal Fungal Pathogens: An Educational Tool, an Online Archive, or a Format in Need of Retooling

“…Severe paracoccidioidomycosis in a 14-year-old boy 200 1/1 [63] a Google Scholar/Scopus [41,42], France [43,44], India [45,46], Italy [47], Iran [48], Japan [49], Malaysia [50], Poland [51], UK [52], and USA [53,54]. There were no other discernible features among this group of case reports to account for the high downloads and citations except for a novelty or rarity of fungal pathogens, for example reports of two cases of multidrug-resistant yeast (Fereydounia khargensis) and of black-grain eumycetoma caused by the rare fungal pathogen Medicopsis romeroi [50,52].…”