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Primary subcutaneous phaeohyphomycosis can rarely be caused by Cladophialophora bantiana. Only two cases have been reported and we present the histologic and culture findings of another. A 32-year-old black female with systemic lupus erythematosus presented with a two-year history of multiple, recurrent, tender, ulcerated skin nodules with purulent drainage involving an area measuring approximately 27.0 × 15.0 cm on her upper back. She had been involved in a tornado at age 10 and had sustained traumatic implantation of wood splinters in this area. Sections of the excision showed scattered dark pinpoint foci with surrounding suppuration extending to the deep aspect of the specimen. Histology demonstrated features of phaeohyphomycosis – foci of granulomatous and acute inflammation with central clusters of dematiaceous fungal hyphae within a fibrotic dermis and subcutaneous tissue. Chains of brown-pigmented septate hyphae and unicellular conidia were identified. Culture revealed pigmented septate, branched hyphae and unbranched acropetal chains of conidia with no attachment hila. Dark gray, velvety colonies formed in one week on a potato dextrose agar plate incubated at 25 degrees Celsius. These culture features were characteristic of Cladophialophora bantiana. Despite surgical excision and itraconazole therapy, her skin lesions persisted for the next two years necessitating a re-excision. |
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