Case report. Atypical cutaneous pseudallescheriosis refractory to antifungal agents.

摘要: We report on a 65-year-old male heart transplant recipient who was otherwise in good condition. The patient immunocompromised secondarily due to cyclosporin, prednisolone and azathioprine when widespread pustular skin lesions with erythematous margins subsequently developed his left forearm. There no history of trauma or septic temperature. Bacterial cultures were sterile the results native cultural investigation studies negative. A biopsy specimen lesion demonstrated hyalohyphomycosis numerous septate hyphae within granulomas throughout dermis. Subcutaneous tissues not involved. Culture plates inoculated pus from punch showed growth mould yielding Pseudallescheria boydii. Sensitivity testing performed miconazole, ketoconazole itraconazole showing best vitro activity against P. In spite treatment itraconazole, erythema pustules continued spread therapy changed intravenous miconazole. Due ongoing progression after 3 months antifungal surgical debridement required. After 2 years follow up, he had recurrence.