Chronic septal panniculitis caused by phaeohyphomycosis

Abstract

Panniculitis is caused by a heterogeneous group of clinical entities that tend to manifest themselves as erythematous-violaceous subcutaneous nodules on the legs. In addition to associations with rheumatic diseases including vasculitis, its causes may include various infections. The microorganisms most commonly involved are bacteria and fungi. Among the latter, Candida Sp,, Nocardia Sp., Sporotrichosis, cryptococcosis, histoplasmosis, cromomycosis, and inter alia, have been described. We present an immu-nocompetent patient with a persistent, neutrophilic, chronic septal panniculitis caused by Aureobasidium Pullulans, an infection-generating fungus belonging to the phaeohyphornycosis group. The patient was treated with amphotericin B 0.5 mg/kg/day, itraconazole 400 mg/day p.o., and 5 fluo-rocytosine 150 mg/kg/day for 4 weeks with excellent response.This is the first report in the literature on panniculitis caused by A. Pullulans's phaeohyphomycosis. We suggest that, whenever we observe patients with symptomatic panniculitis, especially if they are resistant to regular treatment, are of chronic course, and have neutrophilic infiltrates in their biopsies, panniculitis caused by uncommon organisms such as phaeohyphomycosis should be considered in the differential diagnosis.