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

Authors

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

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

Current Medical Mycology
Volume 4, Issue 2
June 2018
Pages 36-39

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History

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

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