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Atypical presence of Pseudallescheria boydii in a soft tissue infection in a patient from Southwest India

Open AccessPublished:August 26, 2022DOI:https://doi.org/10.1016/j.ijid.2022.08.019

      Highlights

      • Infection with Pseudallescheria boydii has increased among immunocompromised patients
      • P. boydii has been shown to be pathogenic in immunocompetent patients
      • It mimics histological features of aspergillosis
      • Early detection reduces the risk of mortality
      • Surgical resection along with appropriate antifungal therapy is advocated

      Keywords

      Pseudallescheria boydii is ubiquitous in nature and one of the most common causes of fungal mycetoma in temperate regions. Traumatic implantation of P. boydii into subcutaneous tissue or aspiration of contaminated water is some of the methods that can result in human infection (
      • Hay RJ.
      Deep mycoses and the skin: subcutaneous mycoses.
      ). This fungus is infamous for its refractoriness toward therapy, predominantly seen in patients who are immunocompromised and resistance to several antifungal agents (
      • Guarro J
      • Kantarcioglu AS
      • Horré R
      • Rodriguez-Tudela JL
      • Cuenca Estrella M
      • Berenguer J
      • et al.
      Scedosporium apiospermum: changing clinical spectrum of a therapy-refractory opportunist.
      ;
      • Tammer I
      • Tintelnot K
      • Braun-Dullaeus RC
      • Mawrin C
      • Scherlach C
      • Schlüter D
      • et al.
      Infections due to Pseudallescheria/Scedosporium species in patients with advanced HIV disease—a diagnostic and therapeutic challenge.
      ). We report an atypical case of P. boydii in a patient with no associated comorbidities. The affected site was in the left foot, characterized by hyperpigmented nodular swelling. It was initially suspected to be invasive aspergillosis because it mimicked its clinical and histological features. The diagnosis was confirmed using a matrix-assisted laser desorption/ionization-time of flight-based automated identification system (BioMerieux, France). Gram stain of the pus from the swelling had shown numerous pus cells and occasional gram-negative bacilli. Calcofluor white stain showed slender, septate, and acute branching hyphae. Smokey-brown, cottony, feathery confluent growth was observed on the surface of the Sabouraud dextrose agar plate. Lactophenol cotton blue mount and 10% KOH (Potassium hydroxide) mount of P. boydii from slide culture showed septate hyphae and annelloconidia under 1000X, as observed under a phase-contrast microscope (Olympus CKX41, Japan). Although current medical therapeutic strategies for P. boydii are limited, successful treatment of the invasive disease revolves around surgical resection and the institution of appropriate antifungal therapy (
      • Bibashi E
      • de Hoog GS
      • Kostopoulou E
      • Tsivitanidou M
      • Sevastidou J
      • Geleris P.
      Invasive infection caused by Pseudallescheria boydii in an immunocompetent patient.
      ;
      • Nesky MA
      • McDougal EC
      • Peacock Jr., JE
      Pseudallescheria boydii brain abscess successfully treated with voriconazole and surgical drainage: case report and literature review of central nervous system pseudallescheriasis.
      ) (Figure 1).
      Figure 1
      Figure 1(a) Hyperpigmented nodular swelling over the dorsum of the left foot. (b) Fungal culture on Sabouraud dextrose agar plate: grayish or smokey-brown cottony feathery confluent growth on surface. (c) Lactophenol cotton blue mount of Pseudallescheria boydii from slide culture showing septate hyphae (yellow arrow) and annelloconidia (red arrows). Magnification: 1000X.

      Funding source

      This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

      Institutional ethical review board

      Written informed consent was obtained from the patient for publication of this report.

      Author contributions

      A.A.A., S.S.V., S.N.: data analyzing, interpretation, validation, literature search, manuscript writing, and review. V.K.K. and S.R.V.: data analyzing, interpretation, validation, literature search, manuscript writing, editing, review, and final draft.

      Declaration of competing interest

      The authors have no competing interests to declare.

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