Cutaneous Phaeohyphomycosis Caused by an Itraconazole and Amphoterecin B Resistant Strain of Veronaeae Botryosa

Int J Dermatol. 2006 Apr;45(4):429-32. doi: 10.1111/j.1365-4632.2006.02619.x.

Abstract

Background: Although the dematiaceous fungus Veronaea botryosa is rarely encountered clinically, it can be pathogenic.

Methods: A patient with a history of diabetes mellitus, coronary artery disease, and Cushing's syndrome had recurrent multifocal, crusted, brownish-red noduloplaques on the right forearm, left upper limb, and right knee. A skin biopsy was obtained for histopathology and fungal cultures.

Results: The histopathology showed brownish hyphae and yeast-like cells scattered in granulomatous infiltrates. Slide cultures revealed erect and straight conidiophores with two-celled cylindrical conidia, which have round tops and truncated bases. The fungus was identified as Veronaea botryosa. The disease slowly progressed despite a 6-month itraconazole regimen (200 mg daily). Subsequent use of Amphoterecin B produced only mild clinical improvements. Susceptibility tests showed resistance to both agents.

Conclusions: Cutaneous phaeohyphomycosis caused by V. botryosa is extremely rare. Antifungal susceptibility tests are important for choosing the appropriate drug and predicting the clinical outcome.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Amphotericin B / pharmacology
  • Antifungal Agents / pharmacology
  • Coronary Artery Disease / complications
  • Cushing Syndrome / complications
  • Dermatomycoses / drug therapy
  • Dermatomycoses / microbiology*
  • Dermatomycoses / pathology
  • Diabetes Complications
  • Drug Resistance, Multiple, Fungal*
  • Humans
  • Itraconazole / pharmacology
  • Male
  • Mitosporic Fungi / isolation & purification*

Substances

  • Antifungal Agents
  • Itraconazole
  • Amphotericin B