Year : 2008 | Volume
: 51 | Issue : 4 | Page : 556--558
K Kiran Kumar, Kaveri Hallikeri
Department of Oral and Maxillofacial Pathology, SDM College of Dental Sciences, Sattur, Dharwad, India
K Kiran Kumar
Department of Oral and Maxillofacial Pathology, SDM College of Dental Sciences, Sattur, Dharwad
Phaeohyphomycosis, caused by heterogeneous group of phaeoid fungi causes both subcutaneous and systemic infections. The disease is more of a histopathological than a clinical entity. We present a case of phaeohyphomycosis in a 29-year-old male who presented with the complaint of painful swelling of the right eye of 1-year duration. Computed tomography (CT) scan showed an abnormal hyper dense enhancing soft tissue in the extra coronal aspect of the right orbit along the superolateral and superomedial aspect. A provisional clinical diagnosis of lymphoma or fungal infection was entertained. Histopathology revealed granulomas with numerous multinucleated giant cells and fungal hyphae within and in between the giant cells. Per-iodic acid Schiff (PAS stain) was used to confirm the presence of hyphae. Based on the clinical, CT and histopathological features, a diagnosis of Phaeohyphomycosis was given.
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Kumar K K, Hallikeri K. Phaeohyphomycosis.Indian J Pathol Microbiol 2008;51:556-558
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Kumar K K, Hallikeri K. Phaeohyphomycosis. Indian J Pathol Microbiol [serial online] 2008 [cited 2020 May 28 ];51:556-558
Available from: http://www.ijpmonline.org/text.asp?2008/51/4/556/43761
The taxonomy and terminology of dematiaceous fungal infections are difficult. The term phaeohyphomycosis was first coined by Ajello in 1974.  Earlier, some of the authors had proposed terms such as chloroblastomycosis.  Later, this term was modified as chloromycosis.  Phaeohyphomycosis is a an infection caused by dematiaceous fungi involving the skin and subcutis, paranasal sinuses or central nervous system.  The term subcutaneous phaeohyphomycosis involves skin and subcutaneous tissue and it is characterised by a nodular or cystic lesion or a pyogranuloma. These hyphae appear to be brown-walled and they are present in the dermis and epidermis.  We report this case due to its clinical presentation.
A 29-year-old male agriculturist reported to the department of Oral Diagnosis and Radiology of a college of dental sciences with a complaint of swelling of right supraorbital region of one year and pain of 6-months duration. The patient was unaware of the swelling till his kin noticed the swelling. The pain was radiating to the temporal region and was of throbbing in nature. He gave history of lachrymal discharge from the right side during sleep. There was history of minor trauma of the supraorbital region while working in the filed.
Local examination showed a papulonodular swelling of approximately 3 2 cm over the supraorbital region. Borders were ill-defined and no ulceration was seen. There was mild displacement and proptosis of the right orbit [Figure 1]. On palpation, the swelling was soft in consistency and nontender. Superficial lymph nodes were not enlarged.
Complete hematological and serological investigations were within the normal limits. The CT scan revealed an abnormal hyper-dense enhancing soft tissue in the extra conal aspect of the right orbit and abnormal hyper-dense soft tissue in the right ethemoidal sinuses with the erosion of the lamina pepyracea and inferolateral aspect of the right frontal sinuses [Figure 2] and [Figure 3]. There was minimal soft-tissue extension within the sinus. Right orbit proptosis was observed [Figure 4].
Fine-needle aspiration (FNA) was performed and the smears revealed multinucleated giant cells, chronic inflammatory cells and branching, septate hyphae. A diagnosis of fungal mass was offered. Incisional biopsy was performed to confirm the diagnosis.
The mass was encapsulated and measured 2 2 cm. Cut section was soft to firm in consistency, homogenous and greyish-white in color. Haematoxylin-and-eosin-stained sections revealed numerous giant cells [Figure 5] and [Figure 6]. Branching, septate and fungal hyphae were observed within and in between the giant cells [Figure 7]. There was diffuse, dense, chronic inflammatory cell infiltrate. Periodic acid Schiff (PAS) and Masson-Fontana stains were positive for the hyphae. In PAS stain, the hyphae appeared bright magenta-colored with branching septae [Figure 8]. Masson-Fontana stain revealed brownish black branching and septate hyphae [Figure 9]. The occupational, clinical and histomorphological features suggested the diagnosis of phaeohyphomycosis, subgroup Veronaea botryose (V. botryose) .
Phaeohyphomycosis is an infection caused by a heterogeneous group of phaeoid fungi. The disease is a histopathological, rather than a clinical entity.  More than 130 fungal species belonging to 70 diverse genera have been reported as causative agents in human and animal phaeohyphomycosis.  Subcutaneous phaeohyphomycosis occurs throughout the world in all climates. In India, the climate ranges from tropical to temperate and the disease has been reported from the extreme north to south, except for the western and eastern regions.  Males are commonly involved because of their outdoor occupation. Eighteen cases of subcutaneous phaeohyphomycosis reported from India, have involved the leg, foot, arm, toes and nails, waist, buttock, left thumb, hand, wrist and some disseminated.  No case with orbital involvement has been reported.
V. botryosa has been isolated from soil and organic materials.  In our case, source of the infection is likely to be from the soil. Ciferri and Montemartini (Cited in ref 9) describe the morphology and histopathology of V.botryosa .
Phaeohyphomycosis is a rare infection caused by dematiaceous fungi, involving the skin and subcutis, paranasal sinuses or central nervous system. We report a case of orbital infection caused by the fungus, morphologically identified as V. botryose.
We would like to acknowledge the support of Prof. C. Bhasker Rao, Principal, SDM Collage of Dental Sciences, Dharwad and Dr. Ravikala Rao Professor and HOD, Department of Pathology, SDM Collage of Medical sciences, Dharwad for assistance in special staining.
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