Successful treatment of invasive stomatitis due to Exophiala dermatitidis in a patient with acute myeloid leukemia.
BACKGROUND
Although the most common orofacial fungal infection in immunocompromised patients is candidosis, infections caused by virulent molds, such as Aspergillus spp. and Furarium spp. are being recognized with increasing frequency. We report a case of oral Exophiala infection in a 39-year-old woman with acute myeloid leukemia.


METHODS
Clinical records of the patient were reviewed and the following additional information was collected: histological and microbiological evidence; identification of the causative organism; in vitro antifungal susceptibility.


RESULTS
The patient developed a necrotic ulcer surrounded by a violaceous rim in the gingiva during neutropenia. Exophiala dermatitidis was identified as the causative organism by histopathological examination and culture, and finally confirmed by sequencing of the ribosomal DNA internal transcribed space domain. In vitro, amphotericin B was found to show strong activity against the Exophiala isolate while itraconazole showed less activity. The patient was successfully treated with parenteral amphotericin B and oral itraconazole in combination with surgical removal of the fungi focus.


CONCLUSIONS
Local excision with adequate antifungal agents can be used to treat immunocompromised patients with Exophiala stomatitis, based on early diagnosis.
Myoken
Yoshinari
Y
Department of Oral Surgery, Hiroshima Red-Cross Atomic Bomb Survivors Hospital, 1-9-6 Senda-machi, Naka-ku, Hiroshima 730-0052, Japan. myoken@do5.enjoy.ne.jp
Sugata
Tatsumi
T
Fujita
Yoshinori
Y
Kyo
Tai-ichi
T
Fujihara
Megumu
M
Katsu
Masakazu
M
Mikami
Yuzuru
Y
D000284:Administration, Oral; D000328:Adult; D000666:Amphotericin B / Q000008:administration & dosage; D000935:Antifungal Agents / Q000008:administration & dosage; D004271:DNA, Fungal / Q000032:analysis; D005093:Exophiala / Q000302:isolation & purification; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D007262:Infusions, Intravenous; D017964:Itraconazole / Q000008:administration & dosage; D015470:Leukemia, Myeloid, Acute / Q000150:complications*; D009181:Mycoses / Q000150:complications / Q000188:drug therapy / Q000382:microbiology* / Q000601:surgery; D009503:Neutropenia / Q000150:complications; D013280:Stomatitis / Q000150:complications / Q000188:drug therapy / Q000382:microbiology* / Q000601:surgery
D000935:Antifungal Agents; D004271:DNA, Fungal; D017964:Itraconazole; D000666:Amphotericin B