Disseminated Subcutaneous Phaeohyphomycosis Due to Cyphellophora sp. In Patient with Homozygous CARD9 Mutation
Keywords:
mycoses, subcutaneous phaeohyphomycosis, skin ulcer, opportunistic infectionsAbstract
Phaeohyphomycosis is an uncommon infection caused by dematiaceous fungi found in soil, water, and wood. Risk factors for acquiring this disease active neoplasia, chemotherapy, among others. Additionally, a mutation in the CARD9 gene is associated with a high risk of developing disseminated infections by dematiaceous fungi. Diagnosis is performed through direct examination, culture, or histopathological study. The treatment is not standardized, but voriconazole, posaconazole, and itraconazole have been described. We present the case of a patient with disseminated nodular subcutaneous phaeohyphomycosis caused by Cyphellophora sp., in association with esophageal candidiasis. The patient was documented to have a mutation in CARD9 gene, representing the first reported case of this type of phaeohyphomycosis caused by this etiological agent in the context of such mutation.
Downloads
References
1. Bonifaz A. ‘Capítulo 29: Feohifomicosis. En: Micología Médica Básica, 6ta edición. Ciudad de México, México: McGRAW-HILL INTERAMERICANA EDITORES, S.A. DE C.V.;2020
2. Diernaes J, Hjuler K, Kristensen L, Deleuran M. Subcutaneous Phaeohyphomycosis due to Alternaria dennisii in an Immunocompromised Patient. Acta Derm Venereol. 2016;96(5):701-2.
3. Arango-Franco CA, Moncada-Vélez M, Beltrán CP, Berrío I, Mogollón C, Restrepo A, et al. Early-Onset Invasive Infection Due to Corynespora cassiicola Associated with Compound Heterozygous CARD9 Mutations in a Colombian Patient. J Clin Immunol. 2018;38(7):794-803.
4. Carrasco-Zuber JE, Navarrete-Dechent C, Bonifaz A, Fich F, Vial-Letelier V, Berroeta-Mauriziano D. Afectación cutánea en las micosis profundas: una revisión de la literatura. Parte 1: micosis subcutáneas. Actas Dermo-Sifiliográficas. 2016;107(10):806-15.
5. Queiroz-Telles F, Nucci M, Colombo AL, Tobón A, Restrepo A. Mycoses of implantation in Latin America: an overview of epidemiology, clinical manifestations, diagnosis and treatment. Med Mycol. 2011;49(3):225-36.
6. Revankar SG, Baddley JW, Chen SCA, Kauffman CA, Slavin M, Vazquez JA, et al. A Mycoses Study Group International Prospective Study of Phaeohyphomycosis: An Analysis of 99 Proven/Probable Cases. Open Forum Infect Dis. 2017;4(4):ofx200.
7. Wang X, Zhang R, Wu W, Song Y, Wan Z, Han W, et al. Impaired Specific Antifungal Immunity in CARD9-Deficient Patients with Phaeohyphomycosis. J Invest Dermatol. 2018;138(3):607-17.
8. Lord AK, Vyas JM. Defensas del anfitrión frente a los hongos patógenos. En: Inmunología clínica: Principios y práctica. Quinta edición. ELSEVIER; 2019. p. 413-24.
9. Voigt K, Cigelnik E, O’donnell K. Phylogeny and PCR Identification of Clinically Important Zygomycetes Based on Nuclear Ribosomal-DNA Sequence Data. J Clin Microbiol. 1999;37(12):3957-64.
10. Petti CA. Interpretive criteria for identification of bacteria and fungi by DNA target sequencing. 2nd edition. Wayne, PA: Clinical and Laboratory Standards Institute; 2018.
11. Layegh P, Tayyebi Meibodi N, Razmyar M, Taghizadeh‐Armaki M, Zarrinfar H. Disseminated phaeohyphomycosis caused by Cyphellophora ludoviensis: A novel case report from Iran. Australas J Dermatol. 2020;61(3):250-2.
12. Bittencourt AL, Machado PRL, Araujo MGS. Subcutaneous phaeohyphomycosis caused by Cyphellophora pluriseptata. Eur J Dermatol EJD. 2002;12(1):103-6.
13. León-Lara X, Atoche C, Arenas R, Martínez-Hernández F, Martínez-Chavarría LC, Xicohtencatl-Cortes J, et al. Cyphellophora laciniata: A new etiological agent of chromoblastomycosis. J Med Mycol. 2022;32(1):101204.
14. Rajandran S, Razali KM, Mustapha M, Palaniappan PA, Amran F. Cyphellophora sp. Isolated from a Corneal Ulcer in the Human Eye. Case Rep Ophthalmol Med. 2020;2020:1-3.
15. Arcobello JT, Revankar SG. Phaeohyphomycosis. Semin Respir Crit Care Med. 2020;41(01):131-40.
16. Lee SO. Diagnosis and Treatment of Invasive Mold Diseases. Infect Chemother. 2023;55(1):10.
17. Zhang L, Zhang Y, Ma Y, Wang Z, Wan Z, Song Y, et al. Challenges towards management of CARD9 ‐deficient patients with phaeohyphomycosis: A case report and case series study. Mycoses. 2023;66(4):317-30.
18. Du B, Shen N, Hu J, Tao Y, Mo X, Cao Q. Complete clinical remission of invasive Candida infection with CARD9 deficiency after G-CSF treatment. Comp Immunol Microbiol Infect Dis. 2020;70:101417.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Sofia González-Velásquez, Miguel González-Velásquez, Simón García-García, Verónica María Molina
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Licencia Creative Commons
La Revista Cubana de Medicina Tropcial se encuentra bajo una
Este sitio está bajo Licencia de Creative Commons Reconocimiento-NoComercial 4.0 Internacional.
