RESEARCH ARTICLE


Chronic Cutaneous Hyalohyphomycosis by Paecilomyces



N. Boufflette1, J.E. Arrese2, P. Leonard3, A.F. Nikkels*, 1
1 Departments of Dermatology
2 Departments of Dermatopathology
3 Departments of Infections Diseases, University Hospital of Liège, Liège, Belgium


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© Boufflette et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: https://creativecommons.org/licenses/by/4.0/legalcode. This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Department of Dermatology, University Hospital of Liège, Liège, Belgium; Tel: +32 4 366 7232; Fax: +32 4 366 7234; E-mail: af.nikkels@chu.ulg.ac.be


Abstract

Paecilomyces lilacinus is a ubiquitous saprophytic fungus that rarely causes infections in humans, frequently affecting the eyes and the skin. Cutaneous and subcutaneous infections mainly occur in immunocompromised hosts but have occasionally been reported in immunocompetent patients. The clinical spectrum is highly heterogeneous and diagnosis is often delayed.

A 60-year-old woman with idiopathic chronic necrotizing vasculitis treated since 10 years with a series of immunosuppressive therapies presented since three years various clinical presentations of chronic hyalohyphomycosis caused by P. lilacinus. Diagnosis was only obtained three years after the first clinical signs, following the histologic analysis of the surgical excision of a cutaneous abscess. Treatment with oral voriconazole was successful.

This case report illustrates the highly heterogeneous clinical aspects of hyalohyphomycosis by P. lilacinus leading to a delay in diagnosis and treatment, particularly in the immunosuppressed patient.

Keywords: Hyalohyphomycosis, immunosuppression, paecilomyces lilacinus, voriconazole, skin infection.