RESUMO
Chromoblastomycosis is a chronic subcutaneous mycosis caused by dematiaceous fungi. Fonsecaea monophora, a new species segregated from F. pedrosoi, may be the most prevalent pathogen of chromoblastomycosis in southern China. Herein, we report a rare case of chromoblastomycosis in a man with nephritic syndrome. He presented with an asymptomatic red plaque on the back of his left wrist that had appeared and enlarged over a period of 1.5 years, without any prior trauma. He was initially diagnosed with sporotrichosis. However, he did not respond to a 6-month course of potassium iodide treatment. The lesion slowly enlarged and became verrucous instead. Concurrently, a similar maculopapule appeared on his left forearm. Histopathological examination of a biopsy specimen indicated the presence of sclerotic bodies in the dermis. The fungus was identified as Fonsecaea spp. based on the results of a slide culture; in addition, the agent was confirmed to be F. monophora by using molecular methods. The patient demonstrated marked improvement after receiving appropriate antifungal therapy for 3 months. To our knowledge, this is the first case of chromoblastomycosis caused by F. monophora in an immunosuppressed patient. The identification of the agent by molecular techniques is important for epidemiological purposes. Thus, we believe that combination therapy with itraconazole and terbinafine would be a suitable option for infections caused by F. monophora.
Assuntos
Ascomicetos/isolamento & purificação , Cromoblastomicose/diagnóstico , Cromoblastomicose/microbiologia , Nefropatias/complicações , Antifúngicos/uso terapêutico , Ascomicetos/classificação , Biópsia , China , Cromoblastomicose/tratamento farmacológico , Cromoblastomicose/patologia , Antebraço/patologia , Histocitoquímica , Humanos , Masculino , Técnicas Microbiológicas , Microscopia , Pessoa de Meia-Idade , Técnicas de Diagnóstico Molecular , Resultado do Tratamento , Punho/patologiaRESUMO
A case of black-grain mycetoma occurring on the lower jaw with an odontogenic origin, which to our knowledge is the first case reported in China, is presented here. The clinical manifestation, histopathological morphology, and microbiological features are described. The new species, Madurella pseudomycetomatis, isolated from the black grains discharged by this patient, was analyzed using sequence data of the multiloci of ribosomal DNA (rDNA) and its ability to ferment carbohydrate as well as morphology. The analyses of the internal transcribed spacer (ITS) region and the D1/D2 hypervariable region of the 28S ribosomal gene sequences support a new species designation. Antifungal susceptibility testing was conducted, indicating that Madurella pseudomycetomatis was highly susceptible to itraconazole, voriconazole, and amphotericin B; moderately susceptible to terbinafine; and resistant to fluconazole and flucytosine.
Assuntos
Doenças Maxilomandibulares/microbiologia , Madurella/classificação , Madurella/isolamento & purificação , Micetoma/diagnóstico , Micetoma/microbiologia , Adulto , Animais , Antifúngicos/farmacologia , China , DNA Fúngico/química , DNA Fúngico/genética , DNA Ribossômico/química , DNA Ribossômico/genética , DNA Espaçador Ribossômico/química , DNA Espaçador Ribossômico/genética , Modelos Animais de Doenças , Feminino , Genes de RNAr , Humanos , Madurella/efeitos dos fármacos , Madurella/genética , Masculino , Camundongos , Camundongos Endogâmicos BALB C , Testes de Sensibilidade Microbiana , Dados de Sequência Molecular , RNA Fúngico/genética , RNA Ribossômico 28S/genética , Análise de Sequência de DNARESUMO
Microsporum gypseum is a geographically widespread geophilic fungus that infects animals and humans. M. gypseum infection on the scrotum is very rare and can be easily misdiagnosed because of a lack of inflammatory reaction. Here we describe a patient with pseudomembranous-like tinea of the scrotum resulting from M. gypseum.