Abstract:

Fungi are emerging as some of the most common opportunistic organisms in immunocompromised patients. They present a diagnostic and therapeutic challenge and are a great cause of morbidity and mortality in susceptible individuals. We present the case of a 58 year old female with end stage renal disease status post renal transplant who presented with multiple ulcero-nodules with purulent exudate on bilateral lower extremities. An initial biopsy was diagnosed as hyalohyphomycosis and was treated with Itraconazole to limited effect. A repeat biopsy was obtained and submitted for routine histopathology; and culture and gram stain. Histology showed a mixed dermal inflammatory infiltrate composed of lymphocytes and neutrophils with occasional multinucleated giant cells. GMS stain demonstrated fungal hyphal elements in the dermis. Culture returned as Purpureocillium lilacinum. The patient was commenced on a three-month course of Voriconazole and resulted in a resolution of her lesions. P. lilacinum (Paecilomyces lilacinus) is a ubiquitous environmental saprobic fungus that has been increasingly implicated in opportunistic fungal infections. It has intrinsic resistance to Amphotericin B but does respond to triazoles such as Voriconazole. Accurate speciation is critical in determining the proper therapeutic strategy.

Financial Disclosure:
No current or relevant financial relationships exist.

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Jeremiah Pasion, MD