A Case Report of Human Cutaneous Neosartorya hiratsukae Infection

Abstract

We present a case of a human cutaneous infection caused by Neosartorya hiratsukae in a 19-year-old male on adalimumab. While on a trip to Israel, the patient sustained a left knee abrasion after a fall while hiking, and subsequently went swimming in the Red Sea. The patient gradually developed a large, non-healing, erythematous, ulcerated plaque on the left knee. Initial biopsy and tissue cultures were negative for infection, but due to a high suspicion for infection, further diagnostic testing was conducted. Broad range polymerase chain reaction and next-generation sequencing was performed, and 28S rDNA sequencing was positive for Neosartorya hiratsukae, a rare infectious agent in humans. This case highlights the importance of considering uncommon sources, such as fungal etiologies, in the differential diagnosis of non-resolving lesions, particularly in immunosuppressed patients. Furthermore, this case emphasizes the significance of advanced molecular techniques in identifying uncommon pathogens.

Keywords: aspergillus; fungal infection; israel; neosartorya hiratsukae; next generation sequencing (ngs); voriconazole.

Figure 1. Left knee rash

Figure 2. Histopathology

Sections reveal a markedly corrugated epidermis with irregular proliferative epithelial hyperplastic and reactive changes without evidence of nuclear atypia. Some spongiosis and neutrophilic/lymphocytic exocytosis is noted. The process extends into the mid reticular dermis. The adjacent dermis shows mixed inflammation including granulomatous inflammation with multinucleated giant cells and plasma cells.