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SHORT COMMUNICATION
Concurrent Double Fungal Infections of the Skin Caused by Phialemoniopsis endophytica and Exophiala
jeanselmei in a Patient with Microscopic Polyangiitis
Ayako ITO 1 *, Nanako YAMADA 1 , Ryoko KIMURA 1 , Natsumi TANAKA 2 , Jun KURAI 2 , Kazushi ANZAWA 3 , Takashi MOCHIZUKI 3
and Osamu YAMAMOTO 1
1
Division of Dermatology, Department of Medicine of Sensory and Motor Organs, 2 Division of Respiratory Medicine and Rheumatology, Faculty
of Medicine, Tottori University, 86 Nishi-cho, Yonago, 683-8503, and 3 Department of Dermatology, Kanazawa Medical University, Ishikawa,
Japan. E-mail: [email protected]
Phaeohyphomycosis is an infection characterized by
melanized hyphae, yeast cells, moniliform hyphae, or a
mix of these morphotypes in tissue. The causative agents
mostly belong to the genera Exophiala and Scedosporium
(1). Hyalohyphomycosis is characterized by hyaline
hyphae, such as Fusarium, Scedosporium, Acremonium,
Scopulariopsis, Purpureocillium and Paecilomyces
(2). We report here a case of concurrent double fungal
infections of the skin caused by 2 different species of
fungi in an immunocompromised patient: hyalohypho-
mycosis of the foot due to Phialemoniopsis endophytica
and phaeohyphomycosis of the hand due to Exophiala
jeanselmei. This is also the first case report of infection
by P. endophytica, which has been described recently as
a new species of Phialemoniopsis.
CASE REPORT
An 87-year-old Japanese man diagnosed with microscopic poly-
angiitis presented with polyneuropathy of the lower extremities
and renal involvement. He was started on therapy with oral
prednisolone, 50 mg daily for a week, following intravenous
methylprednisolone, 1,000 mg for 3 days. After gradually tapering
the dosage, he had been maintained on prednisolone, 10 mg daily,
for 8 years. He was admitted to the department of internal medi-
cine in our hospital for treatment of cholangitis. He had a history
for several months of a nodule on his right ankle and a cyst on
his right hand. Physical examination revealed an asymptomatic