title: Phaeoacremonium parasiticum phaeohyphomycosis in a patient with systemic lupus erythematosus treated successfully with surgical debridement and voriconazole: A case report and review of the literature.
abstract: A 26-year old woman presented for evaluation of extensive edema, erythema, sinus tract formation and purulent drainage from the left lower extremity after trauma from a wooden object approximately three months prior. Skin biopsies and blood cultures revealed Phaeoacremonium parasiticum consistent with a diagnosis of phaeohyphomycosis. Despite hospitalization and initial treatment with several antifungals, including voriconazole, her infection progressed. Surgical debridement with split thickness skin grafting was performed. Subsequent clinical improvement allowed a transition from intravenous to oral voriconazole and discharge home. Seven months post presentation she remained on oral voriconazole with significant improvement and no clinical evidence of recurrence. This case illustrates an approach to management where aggressive debridement with split-thickness skin grafting and a prolonged course of intravenous and oral antifungals resulted in a good long-term outcome for the patient.
authors.affiliation: Department of Internal Medicine, Division of Infectious Diseases, University of Iowa Hospitals and Clinics, United States.
authors.forename: Rima I
authors.initials: RI
authors.lastname: El-Herte
authors.affiliation: Department of Pathology, University of Iowa Hospitals and Clinics, United States.
authors.forename: Katie E
authors.initials: KE
authors.lastname: Schouweiler
authors.affiliation: Department of Dermatology, University of Iowa Hospitals and Clinics, United States.
authors.forename: Ronda S
authors.initials: RS
authors.lastname: Farah
authors.affiliation: McFarland Clinic PC, Ames, IA, United States.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Arbulu
authors.affiliation: Department of Internal Medicine, Division of Infectious Diseases, University of Iowa Hospitals and Clinics, United States.
authors.forename: Daniel
authors.initials: D
authors.lastname: Diekema
authors.affiliation: Department of Pathology, University of Iowa Hospitals and Clinics, United States; Department of Dermatology, University of Iowa Hospitals and Clinics, United States.
authors.forename: Karolyn A
authors.initials: KA
authors.lastname: Wanat
authors.affiliation: Department of Pathology, University of Iowa Hospitals and Clinics, United States.
authors.forename: Bradley A
authors.initials: BA
authors.lastname: Ford
keywords: Management; Mycetoma; Phaeoacremonium; Phaeohyphomycosis
references.citation: Antimicrob Agents Chemother. 2011 Sep;55(9):4485-7
references.pmid: 21690288
references.citation: Nucleic Acids Res. 2008 Jul 1;36(Web Server issue):W5-9
references.pmid: 18440982
references.citation: FEMS Immunol Med Microbiol. 2004 Jan 15;40(1):41-9
references.pmid: 14734185
references.citation: Case Rep Dermatol. 2012 May;4(2):119-24
references.pmid: 22740814
references.citation: J Clin Microbiol. 2011 Mar;49(3):1171-4
references.pmid: 21191052
references.citation: J Clin Microbiol. 2005 Apr;43(4):1752-67
references.pmid: 15814996
references.citation: Int J Antimicrob Agents. 2008 Nov;32(5):418-20
references.pmid: 18762407
references.citation: Med Mycol. 2008 Nov;46(7):745-7
references.pmid: 18608889
references.citation: Nucleic Acids Res. 2013 Jan;41(Database issue):D36-42
references.pmid: 23193287
references.citation: J Am Acad Dermatol. 2012 Feb;66(2):333-5
references.pmid: 22243731
references.citation: Mycologia. 1974 May-Jun;66(3):490-8
references.pmid: 4601425
references.citation: J Clin Microbiol. 2006 Jun;44(6):2207-11
references.pmid: 16757622
references.citation: J Clin Microbiol. 1998 Aug;36(8):2353-5
references.pmid: 9666022
references.citation: Clin Infect Dis. 2009 Apr 15;48(8):1033-41
references.pmid: 19267655