Diagnosis: Disseminated infection with Exserohilum rostratum.
The skin biopsy revealed fungal hyphae with branching forms on Gomori methenamine-silver and periodic acid-Schiff stains, which were surrounded by foci of acute inflammation (Fig. 2). The fungal culture became positive for E. rostratum 6 days later (Fig. 3). A sputum culture was also positive for E. rostratum. Based on the patient's clinical manifestation, microbiologic findings and histopathologic features, a diagnosis of disseminated E. rostratum infection was made.
The authors thank Donald Jungkind, PhD, and Mindy Tokarczyk, from the Department of Microbiology, Thomas Jefferson University Hospital, for their significant help.
1. Larone D, In: Press A. Medically Important Fungi. 4th ed; American Society for Microbiology: Washington; 2002.
2. Mathews MS, Maharajan SV. Exserohilum rostratum causing keratitis in India. Med Mycol
3. Kanungo R, Srinivasan R. Corneal phaeohyphomycosis due to Exserohilum rostratum. A case report and brief review. Acta Ophthalmol Scand
4. Anandi V, George JA, Thomas R, et al. Phaeohyphomycosis of the eye caused by Exserohilum rostratum in India. Mycoses
5. Agarwal A, Singh SM. A case of cutaneous phaeohyphomycosis caused by Exserohilum rostratum, its in vitro sensitivity and review of literature. Mycopathologia
6. Lavoie SR, Espinel-Ingroff A, Kerkering T. Mixed cutaneous phaeohyphomycosis in a cocaine user. Clin Infect Dis
7. Hsu MM, Lee JY. Cutaneous and subcutaneous phaeohyphomycosis caused by Exserohilum rostratum. J Am Acad Dermatol. 1993;28:340-344.
8. Tieman JM, Furner BB. Phaeohyphomycosis caused by Exserohilum rostratum mimicking hemorrhagic herpes zoster. J Am Acad Dermatol
9. Burges GE, Walls CT, Maize JC. Subcutaneous phaeohyphomycosis caused by Exserohilum rostratum in an immunocompetent host. Arch Dermatol
10. Moneymaker CS, Shenep JL, Pearson TA, et al. Primary cutaneous phaeohyphomycosis due to Exserohilum rostratum (Drechslera rostrata) in a child with leukemia. Pediatr Infect Dis
11. Lasala PR, Smith MB, McGinnis MR, et al. Invasive Exserohilum sinusitis in a patient with aplastic anemia. Pediatr Infect Dis J
12. Aviv JE, Lawson W, Bottone EJ, et al. Multiple intracranial mucoceles associated with phaeohyphomycosis of the paranasal sinuses. Arch Otolaryngol Head Neck Surg
13. Douer D, Goldschmied-Reouven A, Segev S, et al. Human Exserohilum and Bipolaris infections: report of Exserohilum nasal infection in a neutropenic patient with acute leukemia and review of the literature. J Med Vet Mycol
14. Aquino VM, Norvell JM, Krisher K, et al. Fatal disseminated infection due to Exserohilum rostratum in a patient with aplastic anemia: case report and review. Clin Infect Dis
15. Sharkey PK, Graybill JR, Rinaldi MG, et al. Itraconazole treatment of phaeohyphomycosis. J Am Acad Dermatol