CASE REPORT   

Gazzetta Medica Italiana - Archivio per le Scienze Mediche 2019 July-August;178(7-8):569-75

DOI: 10.23736/S0393-3660.18.03887-1

Copyright © 2018 EDIZIONI MINERVA MEDICA

language: English

Cutaneous manifestations of Scedosporium apiospermum in an immunosuppressed patient

Federico FACCHIN ^{1, 2} ✉, Luca LANCEROTTO ³, Giorgio GIATSIDIS ⁴, Roberto SALMASO ⁵, Vincenzo VINDIGNI ², Franco BASSETTO ²

¹ Unit of Plastic and Reconstructive Surgery, Department of Medical Sciences, University of Trieste, Trieste, Italy; ² Unit of Plastic and Reconstructive Surgery, Department of Neurosciences, University of Padua, Padua, Italy; ³ Department of Plastic Surgery, St. John’s Hospital, NHS Lothian, Edinburgh, UK; ⁴ Division of Plastic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA; ⁵ Unit of Surgical Pathology and Cytopathology, Department of Medicine (DIMED), University of Padua, Padua, Italy

Scedosporium apiospermum is a ubiquitous fungus of the soil and polluted water responsible for cutaneous and disseminated infection. It is identified as the common cause of mycetoma after trauma in immunocompetent patient and it is recognized as one of the medically important opportunistic fungi causing life-threatening infections in immunosuppressed patients. Cutaneous involvement lacks pathognomonic features that would make an early diagnosis possible. Presentations range from erythematous lesions, abscesses, nodules with purulent discharge to skin plaques, nodules, scaly, crusted surface, granulomatous lesions without signs of infection. A case of deep cutaneous mycosis mimicking a skin cancer is described. The patient was initially treated for an immunosuppressive therapy-related neoplasm. Afterwards the correct histopathological diagnosis was performed, and the patient underwent the proper long-term antifungal treatment. The review of 38 cases collected from the literature underlines the variability of clinical presentations of cutaneous Scedosporium apiospermum. Healthcare providers awareness of clinical aspects and presentation of Scedosporium apiospermum infections and the knowledge of the best treatment options would prevent treatment delay and can be life-saving in immunocompromised patients. The association of early surgical debridement and specific long-term antifungal therapy (based on intraoperative microbiological specimens) offers the best chance of healing, avoiding the risk of dissemination or local recurrence.

KEY WORDS: Scedosporium; Dermatomycoses; Immunosuppression; Skin neoplasms