Title: Primary cutaneous facial phaeohyphomycosis due to Verruconus gallopava (Ochroconus gallopava) in an immunocompetent woman from the Sub-Himalayas – a case report and literature review

Authors: Dr Santwana Verma M.D., Dr Ghanshyam Verma, M.D., Dr Archana Angrup M.D., , Dr M. R. Shivaprakash, M.D. , Mrs. Sunita Gupta M Sc. , Dr Vineeta Sharma M.D.

 DOI: https://dx.doi.org/10.18535/jmscr/v6i10.234

Abstract

Verruconus gallopava is a melanised environmental saprophyte. Human infections of respiratory and central nervous systems occur primarily in immunocompromised subjects. Skin and subcutaneous infections are seen when disease involves multiple sites. Primary cutaneous phaeohyphomycosis is exceptional. We report a case of an immunocompetent female who had facial phaeohyphomycosis with V. galIopava following trauma. Lesions progressed despite antibiotic therapy. Diagnosis was established on fungal culture and she showed some favourable response to itraconazole 200 mg with terbnafine 250 mg at her second visit but was lost to follow up. No single therapeutic regimen is consistently efficacious in V. gallopava infections. Early laboratory confirmation is imperative to achieve success as outcome is variable even with combination of antifungal agents and surgery.

Keywords: Verruconus gallopava, phaeohyphomycosis, itraconazole.

References

  1. Qureshi ZA. Ochroconis gallopava: a dematiaceous mold causing infections in transplant recipients. Clin Transplant. 2012;26(1):17-23.
  2. Fukushiro R. Subcutaneous abscesses caused by Ochroconis gallopavum. J Med Vet Mycol. 1986;24(3):175-182.
  3. Boggild AK. Disseminated phaeohypho-mycosis due to Ochroconis gallopavum in the setting of advanced HIV infection. Med Mycol. 2006;44(8):777-782.
  4. Wang TK. Disseminated Ochroconis gallopavum infection in a renal transplant recipient: the first reported case and a review of the literature. Clin Nephrol. 2003;60(6):415-423.
  5. Malani PN. Disseminated Dactylaria constricta infection in a renal transplant recipient. Transpl Infect Dis. 2001;3(1):40-43.
  6. Wong JS. Ochroconis gallopava peritonitis in a cardiac transplant patient on continuous ambulatory peritoneal dialysis. Transpl Infect Dis. 2010;12:455-458.
  7. Odell JA. Multiple lung abscesses due to Ochroconis gallopavum, a dematiaceous fungus, in a nonimmunocompromised woodpulp worker. Chest. 2000;118:1503-1505.
  8. Seyedmousavi S. Antifungal susceptibility patterns of opportunistic fungi in the genera Verruconis and Ochroconis. Antimicroibial Agents and Chemotherapy. 2014;58:3285-3292.
  9. Samerpitak K. Taxonomy of Ochroconis, genus including opportunistic pathogens on humans and animals. Fungal Diversity. 2014;65:89-126.
  10. Shoham S. Transplant-associated Ochroconis gallopavum infections. Transpl Infect Dis. 2008;10:442-448.
  11. Yarita K. Pathogenicity of Ochroconis gallopava isolated from hot sprimgs in japan and a review of published reports. Mycopathologia. 2007;164:135-147.
  12. Horre R. Primary cerebral infections by melanised fungi: a review. Stud Mycol. 1999;43:176-193.
  13. Sides EH. Phaeohyphomycotic brain abscess due to Ochroconis gallopavum in a patient with malignant lymphoma of a large cell type. J Med Vet Mycol. 1991;29(5):317-322.
  14. Meriden Z. Ochroconis gallopava infection in a patient with chronic granulomatous disease; case report and review of the literature. Med Mycol. 2012;50(8):883-889.
  15. Terreni AA. Disseminated Dactylaria gallopava infection in a diabetic patient with chronic lymphocytic leukemia of the T cell type. Am J Clin Pathol. 1990;94:104-107.
  16. Fukusima N. Disseminated Ochroconis gallopavam infection in a chronic lymphocytic leukemia: a case and review of literature on haematological maligna-ncies. Intern Med 2005;44:879-882.
  17. Bowyer JD. Ochroconis gallopava endopthalmitis in fludarabine treated chronic lymphocytic leukemia. Br J Ophthalmol. 2000;84:117-121.
  18. Zhao J. Pemphigus patient with pulmonary fungal infection caused by Ochroconis gallopava: the first case report in China. Zhonghua Yi Xue Za Zhi 2002;82:1310-1313.
  19. Ohori A. Rapid identification of Ochroconis gallopavaby a loop-mediated isothermal amplification (LAMP) method. Microbiol 2006; 114:359-365. 
  20. Cardeau-Desangles I. Disseminated Ochroconis gallopava infection in a heart transplant patient. Transpl Infect Dis. 2013;15(3):115-118.
  21. Burns KE. Dactylaria gallopava infection presenting as a pulmonary nodule in a single – lung transplant recipient. J Heart Lung Transplant 2000;19:900-902.
  22. Kumaran MS. Disseminated cutaneous Ochroconis gallopava infection in an immunocompetent host: an unusual concurrence – a case report and review of cases reported. Int J Dermatol. 2015;54(3):327-31.
  23. Bravo LO. Ochroconis gallopavum and Mcobactyerium Avium Intercellulare in an Immunocompetent patient. Chest 2004;126(4):975S.
  24. Hollingworth JW. Successful treatment of Ochroconis gallopavum infection in an Immunocompetent host. Infection. 2007;35(5):367-369.
  25. Dixon DM. Morphologic and physiologic studies of three dematiaceous pathogens. J Clin Micobiol. 1986;24(1): 12-15.
  26. Mancini MC. Dactylaria infection of a human being: pulmonary disease in a heart transplant recipient. J Heart Lung Transplant 1992;11:827-830.
  27. Prevost – Smith E. Fatal phaeohyphomycotic infection due to Dactylaria gallopava and Scedosporium prolificans in a cardiac transplant. In: Proceedings and abstracts of the annual 93rd Annual Meeting of the American Society of Microbiology, Atlanta, GA, Washimgton: ASM Press, 1993:F-35.
  28. Vukmir RB. Successful therapy for cerebral phaeohyphomycosis due to Dactylaria gallopavum in a liver transplant patient. Clin Infect Dis 1994; 19:714-719.
  29. Kralovic SM. Phaeohyphomycosis caused by Dactylaria ( human dactylariosis) : report of a case with review of the literature. J Infect 1995; 31: 107 – 113.
  30. Rossmann SN. Dematiaceous fungi are an increasing cause of human disease, Clin Infect Dis 1996;22:73-80.
  31. Bonham A. Central nervous system lesions in liver transplant recepients: Prospective assessment of indications for biopsy and implications for management. In: 15th Annual Meeting of the American Society of Transplantation Physicians, Dallas, TX, 66, 1596, 1998. et al
  32. Jenny A. Pulmonary infection due to Verruconus gallopavum treated successfully after orthotopic heart transplantation. Clin Infect Dis 1998;26:236-237.
  33. Mazur JE. A case report of a Dactylaria fungal infection in a lung transplant individual. Chest 2001; 119;651-653.
  34. Mayer N. A case of pulmonary cavitary lesions due to Dactylaria constricta var. gallopava in a renal transplant patient. Nephrology 2009; 14: 262.
  35. Karthika J. ADR: An atypical presentation of rare dematiaceous fungus. Indian J Med Microbiol. 2014;32(3):336.

Corresponding Author

Dr Ghanshyam Verma, M.D.

Dermatology, Associate Professor, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India

Email: This email address is being protected from spambots. You need JavaScript enabled to view it., Telephone: 0177-2651974(R);   9418031123 (M)