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Case Reports
. 2017 Apr 14;16(1):31.
doi: 10.1186/s12941-017-0195-z.

Recurrent Scedosporium apiospermum mycetoma successfully treated by surgical excision and terbinafine treatment: a case report and review of the literature

Eszter J Tóth  1   2 , Géza R Nagy  3 , Mónika Homa  1   2 , Marianna Ábrók  4 , Ildikó É Kiss  4 , Gábor Nagy  1   2 , Zsuzsanna Bata-Csörgő  3 , Lajos Kemény  3 , Edit Urbán  4 , Csaba Vágvölgyi  2 , Tamás Papp  5   6
Affiliations
Case Reports

Recurrent Scedosporium apiospermum mycetoma successfully treated by surgical excision and terbinafine treatment: a case report and review of the literature

Eszter J Tóth et al. Ann Clin Microbiol Antimicrob. .

Abstract

Background: Scedosporium apiospermum is an emerging opportunistic filamentous fungus, which is notorious for its high levels of antifungal-resistance. It is able to cause localized cutaneous or subcutaneous infections in both immunocompromised and immunocompetent persons, pulmonary infections in patients with predisposing pulmonary diseases and invasive mycoses in immunocompromised patients. Subcutaneous infections caused by this fungus frequently show chronic mycetomatous manifestation.

Case report: We report the case of a 70-year-old immunocompromised man, who developed a fungal mycetomatous infection on his right leg. There was no history of trauma; the aetiological agent was identified by microscopic examination and ITS sequencing. This is the second reported case of S. apiospermum subcutaneous infections in Hungary, which was successfully treated by surgical excision and terbinafine treatment. After 7 months, the patient remained asymptomatic. Considering the antifungal susceptibility and increasing incidence of the fungus, Scedosporium related subcutaneous infections reported in the past quarter of century in European countries were also reviewed.

Conclusions: Corticosteroid treatment represents a serious risk factor of S. apiospermum infections, especially if the patient get in touch with manure-enriched or polluted soil or water. Such infections have emerged several times in European countries in the past decades. The presented data suggest that besides the commonly applied voriconazole, terbinafine may be an alternative for the therapy of mycetomatous Scedosporium infections.

Keywords: Antifungal susceptibility; Corticosteroid therapy; Cutaneous infection; Filamentous fungi; Immunosuppression; Scedosporium apiospermum.

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Figures

Fig. 1
Fig. 1
Edema, erythema and small superficial abscesses (white arrows) on the lower right leg and foot
Fig. 2
Fig. 2
Colony (a) and micromorphology (b) of Scedosporium apiospermum isolate SZMC 23374. Scale bar 10 µm
Fig. 3
Fig. 3
Distribution of subcutaneous Scedosporium infections in Europe since 1990
See this image and copyright information in PMC

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