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On-line version ISSN 1806-4841
An. Bras. Dermatol. vol.85 no.5 Rio de Janeiro Sept./Oct. 2010
IMAGES IN TROPICAL DERMATOLOGY
Rosane Orofino Costa
PhD, Adjunct Professor of Dermatology, School of Medical Sciences, State University of Rio de Janeiro (UERJ). Head of the Mycology Laboratory, Pedro Ernesto Teaching Hospital, Rio de Janeiro, RJ, Brazil
This report shows images of a case of subcutaneous phaeohyphomycosis caused by Exophiala jeanselmei in a patient who has undergone renal transplantation. The paper comments briefly on the disease and emphasizes the need to take this mycosis into account in the differential diagnosis of other dermatoses, including non-infectious dermatoses.
Keywords: Exophiala; Kidney transplant; Mycoses
Phaeohyphomycosis was a nomenclature proposed by Ajello in 19751 and later modified by McGinnis in 19832. The term phaeohyphomycosis defines the diseases caused by fungi growing in the infected tissue as irregular septate brownish hyphae and/or toruloid hyphae, as well as fungal elements with germination (Figure 1). The term should not substitute well-established diseases such as tinea nigra, black piedra or chromomycosis.3 Cases most often present as cutaneous, subcutaneous or systemic skin abscesses and may affect immunologically competent or incompetent individuals. The most common form of presentation is the subcutaneous type, which should form part of the differential diagnosis of several dermatoses including tumoral forms. In the case presented here, the lesion resembles a mycetoma or epidermoid carcinoma (Figure 2). The most common etiological agents are the Exophiala species (Figure 3). 4 Due to the diversity of the etiological agents, hosts and forms of clinical presentation, treatment remains difficult. When the lesion is subcutaneous and well localized, complete surgical removal of the lesion is recommended (Figure 4). If necessary, broad-spectrum antifungal medication may be used, although care must be taken with immunodepressed patients in the case of possible side effects and drug interactions. 5
1. Ajello L. Phaeohyphomycosis: definition and etiology. In: International Conference on the Mycoses. Proceedings, Washington: PAHO, Scient Publ, 1975, 304. p.126-30. [ Links ]
2. McGinnis MR. Chromoblastomycosis and phaeohyphomycosis: new concepts, diagnosis and mycology. J Am Acad Dermatol. 1983;8:1-16. [ Links ]
3. Matsumoto T, Ajello L. Agents of Phaeohyphomycosis. In: Ajello L, Hay RJ, editors. Medical Mycology. Londres: Arnold; 1998. p. 503-24. [ Links ]
4. Lacaz CS, Porto E, Martins JEC, Heins-Vaccari EM, Melo NT. Feo-hifomicose. In: Lacaz CS. Tratado de Micologia Médica. São Paulo: Sarvier; 2002. p. 520-61. [ Links ]
5. Kwon-Chung KJ, Bennett JE. Phaeohyphomycosis. In: Kwon-Chung KJ, Bennett JE. Medical Mycology. Philadelphia: Lea & Febiger; 1992. p.620-77. [ Links ]
Mailing address: Approved by the Editorial Board and accepted for publication on18.08.2010. * Study conducted at Department of Dermatology, Pedro Ernesto Teaching Hospital, State University of Rio de Janeiro (UERJ), Rio de Janeiro, RJ, Brazil.
Av. 28 de Setembro, 87 - 2º andar Vila Isabel
20551 030 Rio de Janeiro - RJ, Brazil
Phone/Fax: +55 21 2587 6622 +55 21 3325 7456
Conflict of interest: None
Financial funding: None
Approved by the Editorial Board and accepted for publication on18.08.2010.
* Study conducted at Department of Dermatology, Pedro Ernesto Teaching Hospital, State University of Rio de Janeiro (UERJ), Rio de Janeiro, RJ, Brazil.