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Year : 2009  |  Volume : 52  |  Issue : 3  |  Page : 454-455
Subcutaneous phaeohypomycosis


Department of Pathology, Chettinad Deemed University, Kanchepuram 603 103, India

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Date of Web Publication12-Aug-2009
 

How to cite this article:
Balamurugan S, Rajsekar, Rao R. Subcutaneous phaeohypomycosis. Indian J Pathol Microbiol 2009;52:454-5

How to cite this URL:
Balamurugan S, Rajsekar, Rao R. Subcutaneous phaeohypomycosis. Indian J Pathol Microbiol [serial online] 2009 [cited 2019 Dec 13];52:454-5. Available from: http://www.ijpmonline.org/text.asp?2009/52/3/454/55034


Sir,

Phaeohyphomycosis is a rare and sporadically reported mycotic infection of humans and lower animals caused by a number of dematiaceous (brown-pigmented) fungi. Ajello et al ., [1] listed 71 species from 39 genera as causative agents of phaeohyphomycosis. These organisms are widespread in the environment, being found in the soil, wood, and decomposing plant debris. Infection results from traumatic implantation and occurs worldwide, but is more common in tropical and subtropical climates. Clinical forms of phaeohyphomycosis range from localized superficial infections of the stratum corneum (tinea nigra) to subcutaneous cysts (phaeomycotic cyst) to invasion of the brain. The diagnosis of phaeohyphomycosis on tissue sections should be suspected in cases of unexplained subcutaneous abscess or cystic granuloma and confirmed by the finding of dematiaceous fungal elements, best visualized with fungal stain Grocott's Methanamine Silver (GMS). Culture is needed for a specific identification of the etiological agent. We present herewith a case of subcutaneous phaeohyphomycosis and review the literature.

A 60-year-old lady presented with a painless nodule over the wrist joint. No history of trauma could be elicited. A clinical diagnosis of ganglion was made. The nodule was surgically resected and sent for histopathological examination. Gross examination showed a 1.5 1 1 cm lesion in the lower dermis. Cut section was cystic. Microscopically, there was a pseudocystic lesion in the lower dermis and subcutis lined by granulation tissue composed of histiocytes including epithelioid cells, multinucleate giant cells, lymphocytes and plasma cells. Fungal hyphae showing irregular branching and constrictions around the septae giving yeast-like appearance were found lying free and within the giant cells. Fungal elements were easily identified on hematoxylin and eosin stain, better seen on GMS stain [Figure 1] and [Figure 2]. A diagnosis of subcutaneous phaeohyphomycosis was made based on the presentation as cystic granuloma, identification of typical fungal hyphae and absence of sclerotic bodies. Culture for species identification could not be performed as the tissue was already fixed in formalin.

Subcutaneous phaeohyphomycosis is caused by dematiaceous mycelia-forming fungi and is distinguished from mycetoma by the absence of grain (organized, interwoven mycelial aggregates) formation, and from chromoblastomycosis by the absence of sclerotic bodies (thick-walled muriform cells). Though common in tropics, it occurs worldwide; cases have been reported in the United Kingdom in which lesions have clinically mimicked tuberculous cold abscesses. The clinical and histopathological features of subcutaneous phaeohyphomycosis have been described by O'Donnel and Hutt [2] in a large series of nine patients from Malawi. According to Sharma et al ., [3] who have reviewed the literature on subcuataneous phaeohyphomycosis, 23 patients with subcutaneous phaeohyphomycosis have been reported from India. The age of the patients ranged from three to 60 years, with a male to female ratio of 1.3: 1. The present case is a lady in the sixth decade of life. Infection occurs in 85% of the cases in the upper and lower limbs but less frequently, lesions are localized on the buttocks, face, neck and scalp. They usually appear as solitary subcutaneous cysts or abscesses, firm to fluctuant, usually sparing the overlying skin. Our case had a fluctuant nodule over the wrist which prompted a clinical diagnosis of ganglion. Thirteen species from seven genera of dematiaceous fungi were isolated. Phialophora dermatidis was the most common isolate. Exophiala dermatidis seems to be associated with more fatalities. [4] Unfortunately, since the diagnosis was made after formalin fixation no culture could be done. This case is presented to emphasize the fact that phaeohyphomycosis should be kept in mind whenever any unexplained nodule or subcutaneous abscess in the extremity is clinically evaluated.

 
   References Top

1.Ajello L, Georg LK, Steigbigel RT,Wang CJ. A Case of phaeohyphomycosis caused by a new species of Phialophora. Mycologia 1974;66:490-8.  Back to cited text no. 1  [PUBMED]  
2.O'Donnell PJ, Hutt MS. Subcutaneous Phaeohyphomycosis: a0 histopathological study of nine cases from Malawi. J Clin Pathol 1985;38:288-92.  Back to cited text no. 2  [PUBMED]  [FULLTEXT]
3.Sharma NL, Mahajan V, Sharma RC, Sharma A. Subcutaneous pheohyphomycosis in India - a case report and review. Int J Dermatol 2002;41:16-20.  Back to cited text no. 3    
4.Ziefer A, Connor DH. Phaeomycotic cyst. A clinicopathologic study of twenty-five patients. Am J Trop Med Hyg 1980;29:901-11.  Back to cited text no. 4    

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Correspondence Address:
S Balamurugan
3 D KG Traditions, 1 North Gopalapuram First Street, Chennai - 600 086
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0377-4929.55034

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