Akademik Veri Yönetim Sistemi
Balkan Fungus 2022, Thessaloniki, Yunanistan, 6 - 08 Ekim 2022, ss.65
Objective: In recent years, the incidence of infection by S. apiospermum species complex has risen as a result of the widespread use of corticosteroids, broad-spectrum antibiotics, immunosuppressants, and antineoplastics. Here, we present a case of cutaneous S. apiospermum species complex infection in a woman with asthma, diabetes mellitus, atrial fibrillation, and hypertension, who was receiving long-term therapy with corticosteroids. We also reviewed the literature published on cutaneous Scedosporium infections.
Case Report: Our patient, 75 year-old woman, was hospitalized at the Department of Chest Disease for the follow-up of worsened dyspnea, cor pulmonale, and stasis dermatitis. Erythema, localized tenderness, and swelling developed on her left foot dorsum and foot during her follow-up in hospital. A few days later, black-colored papules on her foot dorsum and anterior surface of the tibia were observed in an erythematous base. A Skin biopsy was performed and revealed numerous septated fungal hyphae. Preemptive amphotericin B was started. Within 48 h of incubation, the Scedosporium colony was isolated based on conventional methods. Fungal ribosomal RNA gene internal transcribed spacer (ITS) sequence analysis revealed Scedosporium apiospermum and deposited into Genbank with accession number OM948685. The minimum inhibition concentration (MIC) was defined as 1μg/ml for amphotericin B; 16μg/ml for fluconazole; 0,25μg/ml voriconazole, 4μg/ml for caspofungin, 1μg/ml for itraconazole and 0,125μg/ml for posaconazole on 48 h of incubation. Antimicrobial treatment was modified to caspofungin/ voriconazole combination and imipenem administration. Hepatic failure, bone marrow suppression with severe thrombocytopenia, and disseminated intravascular coagulation (DIC) syndrome had developed on the 3rd day of ICU stay. The patient died from severe septic shock and multiorgan failure.
Review of the Literature: A total of 25 cutaneous scedosporiosis cases were evaluated which were published between the years 1997 and 2022. Cutaneous lesions are generally nodular, imitating lymphocutaneous sporotrichosis, but in some cases presented papules and plaques. Some cases were immunosuppressed but some of them were not.
Conclusion: Scedosporiosis is an emerging fungal infection among immunocompromised and immunocompetent individuals which even when recognized and treated leaves individuals with potential severe deficits. Scedosporium species are distinctively difficult to treat since they present inherent resistance to available antifungal agents.