Abstract:

Phaeohyphomycosis is a fungal infection caused by dematiaceous fungi, a group characterized by the presence of melanin in their cell walls. These fungi are ubiquitous in the environment, and infection is uncommon. Subcutaneous phaeohyphomycosis typically results from wound contamination or traumatic inoculation but has a wide variety of clinical manifestations. Although these infections often stay localized, they may also disseminate, especially in immunocompromised individuals, requiring a different management approach in these situations or in anticipation of them. Here we report a case series of three patients diagnosed with subcutaneous phaeohyphomycosis. One patient with no history of immunocompromise presented with a sclerotic pink papule on the arm which only required continued monitoring. On the other hand, an immunocompromised patient presented with a 6-year draining, worsening wound on the arm which indurated and became tender. Another immunocompromised patient had a neck nodule, neck stiffness, and headache and was found to have phaeohyphomycosis lesions in the subcutaneous neck as well as the cerebellum. Both these immunocompromised patients received systemic antifungal therapy with posaconazole and voriconazole, respectively. Phaeohyphomycosis is an uncommon fungal disease which can affect both immunocompetent and immunosuppressed patients, but the presentations can vary. Clinicians should be aware of the possibility of disseminated disease in order to work up and treat their patients appropriately.

Financial Disclosure:
No current or relevant financial relationships exist.

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Minh Chung, BE