Abstract
Here we report a case of a 55-year-old Indian male presenting with multiple subcutaneous cysts, which developed from painful nodules at the dorsal right wrist joint. Subsequently a painful nodule appeared on the left knee joint. Cytological examination of the knee swelling revealed a suppurative inflammatory lesion consisting of neutrophils, lymphocytes, multinucleated giant cells and few fungal elements, without involvement of the overlying skin. Exophiala spinifera was cultured (CBS 125607) and its identity was confirmed by sequencing of the internal transcribed spacer (ITS rDNA). The cysts were excised surgically, without need of additional antifungal therapy. There was no relapse during one-year follow-up and the patient was cured successfully. In vitro antifungal susceptibility testing showed that posaconazole (0.063 μg/ml) and itraconazole (0.125 μg/ml) had the highest and caspofungin (4 μg/ml) and anidulafungin (2 μg/ml) the lowest activity against this isolate. However, their clinical effectiveness in the treatment of E. spinifera infections remains to be evaluated. In this case report, we have also compiled cases of human E. spinifera mycoses which have been reported so far.
Acknowledgements
This study was supported by a grant (No. 13081) to H. Badali from the Ministry of Health and Medical Education of Islamic Republic of Iran and the School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.
Declaration of interest: J. F. Meis received grants from Astellas, Merck, Basilea and Schering-Plough. He has been a consultant to Basilea, Merck and Schering- Plough and received speaker's fees from Merck, Pfizer, Schering-Plough and Janssen Pharmaceutica. All the other authors report no potential conflicts of interest. The authors alone are responsible for the content and writing of the paper.
This paper was first published online on Early Online on 7 September 2011.