Abstract
An 81-yaer-old female visited the outpatient clinic of the Isahaya Health Insurance General Hospital on 2004 for medical consultation concerning a crusted, dark-brown, erythematous plaque on her left leg. She had been using prednisolone 15 mg per day since 2001 and cyclophosphamide 50 mg per day since 2005 to treat ANCA (anti-neutrophil cytoplasmic autoantibody)-related vasculitis. Histopathological examination of a biopsy specimen suggested sporotrichosis, but the diagnosis could not be determined because culture of the specimen was negative. She stopped visiting the hospital and could not be followed up. On 2007, she reappeared with the same symptoms. A potassium hydroxide mount examination of the crust from the lesion revealed numerous brownish fungus elements. The lesion was surgically removed. Histopathologically, epithelioid cell granulomas including hyphae and spores were seen in the dermis and were compatible with phaeohyphomycosis. Culture resulted in growth of a black colony. The morphological findings of the fungus identified it as Exophiala jeanselmei (E. jeanselmei). The isolated fungus was further identified as E. xenobiotica, separated from E. jeanselme complex in 2006, by the base sequence of internal transcribed spacer (ITS) region. There was no recurrence of the lesion until March of 2008. We stress the necessity to consider rare infectious diseases in compromised patients. Our case is the first report of phaeohyphomycosis due to E. xenobiotica in Japan.
