Abstract:

A 16-year-old male presented with a 11-year history of progressively enlarging erythema and crusting on the right cheek. Physical examination revealed an irregularly shaped, sharply marginated, dark erythematous patch sized 6 cm × 10 cm and plaques with mild verrucous proliferation. There were strip-like scar at the margin of lesions and multiple ulcers measuring 0.5 to 1 cm in diameter with firm crusts. No small jelly-colored nodules were observed. Direct microscopy of multiple scrapings under the crusts showed many light brown, septate, branching and irregular hyphae. Olivaceous-black woolly colonies grew at 25 ℃ and 35 ℃ on Sabouraud′s dextrose agar and potato dextrose agar; flask-shaped conidiogenous cells with funnel-shaped collarettes and ellipsoidal conidia arranged in flower-like shape were observed microscopically. PAS staining showed numerous septate and branching hyphae, pseudohyphae and yeast-like cells. There was a 99.73% similarity in the species-specific rDNA sequence between the isolate and phialophora verrucosa standard strain CDC-B2152. The patient was diagnosed with cutaneous phaeohyphomycosis caused by Phialophora verrucosa. The lesion subsided after treatment with amphotericin B and itraconazole, but recurred after drug withdrawal. Itraconazole and terbinafine were administered for the retreatment of this patient.

Key words: phaeohyphomycosis