Abstract:

Environmental factors such as global climate change and an increased prevalence of immunocompromised individuals, owing to medical advances, is resulting in a steady rise in the rate of fungal infections that are otherwise rare in immunocompetent hosts. One such genus of ubiquitous opportunistic pathogenic and multi-drug resistant fungi, Scedosporium, can cause infections in both immunocompetent and immunocompromised human hosts. Scedosporium fungi, in immunocompromised hosts, are increasingly being recognized as significant pathogens and account for approximately 25% of non-Aspergillus related disseminated and cutaneous mycelial infections in immunocompromised patients. Due to the morphologic similarities between Scedosporium and Aspergillus spp., Fusarium spp., and other hyphomycete fungi, infections with Scedosporium represent a unique histologic diagnostic challenge leaving detection and recovery by culture the cornerstone of diagnosis. We present a case of an 87-year-old male with clinical history significant for myelodysplastic syndrome with rising blasts who presented with right upper lobe pneumonia, Acinetobacter bacteremia and a rapidly enlarging tender nodule on the dorsal foot. Biopsy of the nodule revealed a deep abscess associated with a large aggregate of fungal hyphae (septate and branching) with morphologic features suggestive of Aspergillus. Subsequent culture grew Scedosporium. Due to the morphological similarities between Scedosporium and Aspergillus, its increasing prevalence within the environment, and the implications for therapy, we wanted to bring this potential diagnostic pitfall to the attention of the greater dermatopathology community.

Financial Disclosure:
No current or relevant financial relationships exist.

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Nadeem Marghoob