title: Disseminated cutaneous Curvularia infection in an immunocompromised host; diagnostic challenges and experience with voriconazole.
abstract: An increasing spectrum and number of opportunistic fungal pathogens have been reported to cause disease in humans over the past decade. Disseminated phaeohyphomycoses caused by rare dematiaceous molds in immunocompromised patients have a high mortality rate and are increasingly reported in the literature. Early diagnosis of disseminated phaehyphomycosis is critical especially in neutropenic patients but can be hindered by the low sensitivity of fungal blood cultures and low clinical suspicion. Cutaneous manifestations are often the earliest sign of disease and conducting a thorough skin exam in febrile neutropenic patients can lead to more rapid diagnosis and initiation of treatment. PCR amplification and sequencing of mold RNA extracted from paraffin-embedded tissue can be useful for diagnosing rare fungal infections when negative fungal cultures preclude morphologic diagnosis. Effective treatment for disseminated phaehyphomycosis is lacking and there is a need to report experiences with the use of newer antifungals.
authors.affiliation: Department of Pathology and Laboratory Medicine, University of Vermont Medical Center, Burlington, VT, USA.
authors.forename: Agnes
authors.initials: A
authors.lastname: Balla
authors.affiliation: Department of Dermatology, University of Vermont Medical Center, Burlington, VT, USA.
authors.forename: Joseph
authors.initials: J
authors.lastname: Pierson
authors.affiliation: Department of Dermatology, University of Vermont Medical Center, Burlington, VT, USA.
authors.forename: Jeremy
authors.initials: J
authors.lastname: Hugh
authors.affiliation: Department of Pathology and Laboratory Medicine, University of Vermont Medical Center, Burlington, VT, USA.
authors.forename: Christina
authors.initials: C
authors.lastname: Wojewoda
authors.affiliation: Department of Pathology and Laboratory Medicine, University of Vermont Medical Center, Burlington, VT, USA.
authors.forename: Pamela
authors.initials: P
authors.lastname: Gibson
authors.affiliation: Department of Pathology and Laboratory Medicine, University of Vermont Medical Center, Burlington, VT, USA.
authors.forename: Laura
authors.initials: L
authors.lastname: Greene
mesh_terms: D000328:Adult; D001203:Ascomycota; D003881:Dermatomycoses / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology / Q000276:immunology; D005260:Female; D006801:Humans; D016867:Immunocompromised Host / Q000276:immunology*; D009503:Neutropenia / Q000150:complications / Q000276:immunology; D065819:Voriconazole / Q000008:administration & dosage*
chemical_list: D065819:Voriconazole
keywords: acute myelogenous leukemia; fungal infection; infectious diseases; molecular pathology; pathology dermatopathology