Phaeoacremonium parasiticum phaeohyphomycosis in a patient with systemic lupus erythematosus treated successfully with surgical debridement and voriconazole: A case report and review of the literature

Rima I El-Herte; Katie E Schouweiler; Ronda S Farah; Ricardo Arbulu; Daniel Diekema; Karolyn A Wanat; Bradley A Ford

doi:10.1016/j.idcr.2014.10.004

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Phaeoacremonium parasiticum phaeohyphomycosis in a patient with systemic lupus erythematosus treated successfully with surgical debridement and voriconazole: A case report and review of the literature

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Phaeoacremonium parasiticum phaeohyphomycosis in a patient with systemic lupus erythematosus treated successfully with surgical debridement and voriconazole: A case report and review of the literature

Rima I El-Herte, Katie E Schouweiler, Ronda S Farah, Ricardo Arbulu, Daniel Diekema, Karolyn A Wanat and Bradley A Ford

IDCases, Vol.1(4), pp.84-88

2014

DOI: 10.1016/j.idcr.2014.10.004

PMCID: PMC4735079

PMID: 26839782

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Abstract

•Purulent drainage, woody induration and sinus tract formation suggest mycetoma.•Phaeohyphomycosis management may require debridement and prolonged antifungal therapy.•Microbiological identification is needed for optimal medical management. A 26-year old woman presented for evaluation of extensive edema, erythema, sinus tract formation and purulent drainage from the left lower extremity after trauma from a wooden object approximately three months prior. Skin biopsies and blood cultures revealed Phaeoacremonium parasiticum consistent with a diagnosis of phaeohyphomycosis. Despite hospitalization and initial treatment with several antifungals, including voriconazole, her infection progressed. Surgical debridement with split thickness skin grafting was performed. Subsequent clinical improvement allowed a transition from intravenous to oral voriconazole and discharge home. Seven months post presentation she remained on oral voriconazole with significant improvement and no clinical evidence of recurrence. This case illustrates an approach to management where aggressive debridement with split-thickness skin grafting and a prolonged course of intravenous and oral antifungals resulted in a good long-term outcome for the patient.

Phaeohyphomycosis

Phaeoacremonium

Management

Mycetoma

Details

Title: Subtitle: Phaeoacremonium parasiticum phaeohyphomycosis in a patient with systemic lupus erythematosus treated successfully with surgical debridement and voriconazole: A case report and review of the literature
Creators: Rima I El-Herte - Department of Internal Medicine, Division of Infectious Diseases, University of Iowa Hospitals and Clinics, United States
Katie E Schouweiler - Department of Pathology, University of Iowa Hospitals and Clinics, United States
Ronda S Farah - Department of Dermatology, University of Iowa Hospitals and Clinics, United States
Ricardo Arbulu - McFarland Clinic PC, Ames, IA, United States
Daniel Diekema - Department of Internal Medicine, Division of Infectious Diseases, University of Iowa Hospitals and Clinics, United States
Karolyn A Wanat - Department of Pathology, University of Iowa Hospitals and Clinics, United States
Bradley A Ford - Department of Pathology, University of Iowa Hospitals and Clinics, United States
Resource Type: Journal article
Publication Details: IDCases, Vol.1(4), pp.84-88
DOI: 10.1016/j.idcr.2014.10.004
PMID: 26839782
PMCID: PMC4735079
NLM abbreviation: IDCases
ISSN: 2214-2509
eISSN: 2214-2509
Publisher: Elsevier Ltd
Language: English
Date published: 2014
Academic Unit: Dermatology; Infectious Diseases; Pathology; Internal Medicine
Record Identifier: 9983986256502771

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