Current Medical Mycology

Current Medical Mycology

An unusual case of hyalohyphomycosis due to Purpureocillium lilacinum in a patient with myasthenia gravis

Authors
Ramya Raghavan 1
Gomathi Chithra 1
Sanal Fernandaz 2
Bettadpura Shamana Suryanarayana 2
Rakesh Singh 1
1 Department of Microbiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
2 Department of Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
10.18502/cmm.4.2.62
Abstract
Background and Purpose: Purpureocillium lilacinum (previously known as Paecilomyces lilacinus) and Paecilomyces variotii cause hyalohyphomycosis.

Case report: In this study, we present a case of multiple subcutaneous abscesses of the lower limbs due to Purpureocillium lilacinum in a patient with myasthenia gravis and uncontrolled diabetes. Subcutaneous involvement of the lower limbs with this fungus is an unusual presentation. Pus aspirate collected on multiple occasions revealed hyaline septate hyphae under microscopic examination and Purpureocillium lilacinum grew on Sabouraud Dextrose Agar. The patient was initially treated by surgical excision and itraconazole therapy. Swelling regressed but discharge was noticed from the excision site after three months of itraconazole therapy. Culture from the discharge material yielded the same fungal growth. Treatment was changed to ketoconazole and he responded.

Conclusion: This case report emphasizes the importance of identifying Purpureocillium lilacinum at an unusual site like the lower limbs in an immunocompromised patient. Ketoconazole may be used as an alternative treatment option for hyalohyphomycosis caused by Purpureocillium lilacinum.
Keywords
Hyalohyphomycosis
Immunocompromised patient
Myasthenia gravis
Paecilomyces lilacinus
Purpureocillium lilacinum
Current Medical Mycology
Volume 4, Issue 2
June 2018
Pages 36-39

  • Receive Date 09 July 2019
  • Revise Date 09 October 2020
  • Publish Date 01 June 2018