Community-acquired Disseminated Exophiala dermatitidis Mycosis with Necrotizing Fasciitis in Chronic Graft-versus-host Disease

Eiichi Sato; Atsushi Togawa; Michio Masaki; Akihiko Shirahashi; Midori Kumagawa; Yasumasa Kawano; Hiroyasu Ishikura; Yuri Yamashiro; Satoshi Takagi; Hiromi To; Katsumi Kobata; Morishige Takeshita; Koji Kusaba; Eisaburo Sueoka; Kazuo Tamura; Yasushi Takamatsu; Tohru Takata

doi:10.2169/internalmedicine.1706-18

This article has now been updated. Please use the final version.

Community-acquired Disseminated Exophiala dermatitidis Mycosis with Necrotizing Fasciitis in Chronic Graft-versus-host Disease

Eiichi Sato, Atsushi Togawa, Michio Masaki, Akihiko Shirahashi, Midori Kumagawa, Yasumasa Kawano, Hiroyasu Ishikura, Yuri Yamashiro, Satoshi Takagi, Hiromi To, Katsumi Kobata, Morishige Takeshita, Koji Kusaba, Eisaburo Sueoka, Kazuo Tamura, Yasushi Takamatsu, Tohru Takata

Author information

Eiichi Sato
Division of Medical Oncology, Hematology, and Infectious Diseases, Department of Internal Medicine, Faculty of Medicine, Fukuoka University, Fukuoka University Hospital, Japan
Atsushi Togawa
Division of Medical Oncology, Hematology, and Infectious Diseases, Department of Internal Medicine, Faculty of Medicine, Fukuoka University, Fukuoka University Hospital, Japan
Michio Masaki
Division of Medical Oncology, Hematology, and Infectious Diseases, Department of Internal Medicine, Faculty of Medicine, Fukuoka University, Fukuoka University Hospital, Japan
Akihiko Shirahashi
Division of Medical Oncology, Hematology, and Infectious Diseases, Department of Internal Medicine, Faculty of Medicine, Fukuoka University, Fukuoka University Hospital, Japan
Midori Kumagawa
Division of Medical Oncology, Hematology, and Infectious Diseases, Department of Internal Medicine, Faculty of Medicine, Fukuoka University, Fukuoka University Hospital, Japan
Department of Blood Transfusion, Fukuoka University Hospital, Japan
Yasumasa Kawano
Department of Emergency and Critical Care Medicine, Fukuoka University Hospital, Japan
Hiroyasu Ishikura
Department of Emergency and Critical Care Medicine, Fukuoka University Hospital, Japan
Yuri Yamashiro
Department of Plastic and Reconstructive Surgery, Fukuoka University Hospital, Japan
Satoshi Takagi
Department of Plastic and Reconstructive Surgery, Fukuoka University Hospital, Japan
Hiromi To
Department of Clinical Laboratory Medicine, Fukuoka University Hospital, Japan
Katsumi Kobata
Department of Pathology, Fukuoka University Hospital, Japan
Morishige Takeshita
Department of Pathology, Fukuoka University Hospital, Japan
Koji Kusaba
Department of Laboratory Medicine, Saga University Hospital, Japan
Eisaburo Sueoka
Department of Laboratory Medicine, Saga University Hospital, Japan
Kazuo Tamura
Division of Medical Oncology, Hematology, and Infectious Diseases, Department of Internal Medicine, Faculty of Medicine, Fukuoka University, Fukuoka University Hospital, Japan
Yasushi Takamatsu
Division of Medical Oncology, Hematology, and Infectious Diseases, Department of Internal Medicine, Faculty of Medicine, Fukuoka University, Fukuoka University Hospital, Japan
Tohru Takata
Division of Medical Oncology, Hematology, and Infectious Diseases, Department of Internal Medicine, Faculty of Medicine, Fukuoka University, Fukuoka University Hospital, Japan
Department of Infection Control, Fukuoka University Hospital, Japan

Keywords: Exophiala dermatitidis, chronic graft versus host disease (GVHD), phaeohyphomycosis, immunosuppressive drug, acute myeloid leukemia, necrotizing fasciitis

JOURNAL OPEN ACCESS Advance online publication

Article ID: 1706-18

DOI https://doi.org/10.2169/internalmedicine.1706-18

The final version of this article is now available: Vol. 58 (2019), No. 6 pp. 877-882

Details

Abstract

We herein report a case of systemic phaeohyphomycosis by Exophiala dermatitidis (E. dermatitidis) with chronic graft-versus-host disease (GVHD) after allogeneic hematopoietic stem cell transplantation (HSCT). The patient had been taking oral corticosteroids for years to control the GVHD. Yeast-like fungi were identified in a blood culture, so treatment with micafungin (150 mg/day) was begun, with no improvement. The patient passed away on hospital Day 12. A sequence analysis of rRNA revealed the isolate to be E. dermatitidis. This report brings attention to an emerging mycosis of community-acquired Exophiala species infection in the very-late phase after allogenic HSCT in patients with chronic GVHD.

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