Microsurgical Debridement for Persistent Ulcers Due to Rare Fungus Infection: Case Report and Literature Review

Abstract

A patient suffered from chronic ulcer due to recalcitrant fungal infection for 3.5 years. Five antifungal agents and 40 times of debridement-all failed. Finally, radical microscopic debridement was performed for eradication of fungal conidiospores. Since then, there was no recurrence at 2 years of follow-up. Scopulariopsis brevicaulis is one of the rarest pathogens of cutaneous fungal infections, for which multidrug resistance increased the complexity and difficulty of treatment. Radical excision, especially microscopic debridement, was the key for eradication of fungal conidiospores in this case.

Keywords: Scopulariopsis brevicaulis; antifungal agents; fungal infections; microsurgical debridement; wounds and injuries.

Fig. 1

( A ) The leg MRI revealed wound infection around right knee with prepatellar bursitis and mild deep infrapatellar bursitis. ( B ) Increased fat stranding and heterogeneous enhancement of anterior aspect of right knee, from suprapatellar region to infrapatellar region, compatible with residual cellulitis.

Fig. 2

( A ) Pathology image of Scopulariopsis brevicaulis infection under H&E stain with 20× magnification. The section revealed ulceration with inflamed granulation tissue and abscess formation of subcutaneous tissue. The conidiospores could be seen in a cinnamon-brown cell wall, with long septate hyphae. ( B ) Abundant fungal elements are highlighted by GMS stain with 20× magnification. ( C ) Abundant fungal elements are highlighted by PAS stain with 20× magnification.

Fig. 3

( A ) One year after the traffic accident, the right knee chronic ulcer had poor healing with erythematous change and pus formation. ( B ) One day after microscopic debridement, fungal elements from the wound were eradicated. ( C ) After 3.5 years of debridement, the right leg wound had healed well with no recurrence at 2 years of follow-up.