title: Subcutaneous Phaeohyphomycosis Cyst Associated with Medicopsis romeroi in an Immunocompromised Host.
abstract: An 88-year-old man, receiving prednisolone for sarcoidosis, presented with a discrete keratotic lesion on the dorsum of his right hand following the placement of an intravenous cannula a month prior to its appearance. Medicopsis romeroi was isolated from the tissue and identified by sequencing the internal transcribed spacer region ITS-1 and the D1-2 fragment of the 28S rDNA gene. Histopathological examination showed fungal hyphae in the internal inflammatory cells layer and within the histocyte-macrophage layer, highly suggestive of deep mycosis. The patient was successfully treated with surgical excision of the cyst. M. romeroi exhibited high MIC values for echinocandin drugs in vitro, but appeared susceptible to newer triazole agents, amphotericin B and terbinafine. This is the first report of a subcutaneous phaeohyphomycotic cyst occurring following the placement of an intravenous cannula. This report highlights the potential role of M. romeroi as an emerging cause of deep, non-mycetomatous infection in immunocompromised patients.
authors.affiliation: Department of Medical Microbiology, 4th Floor East Wing Laboratory Block, Charing Cross Hospital, Imperial College Healthcare NHS Trust, Fulham Palace Road, London, W6 8RF, UK. ali_reza878@yahoo.com.|Fungal Pathogens Immunobiology Laboratory, National Heart and Lung Institute, Imperial College London, London, UK. ali_reza878@yahoo.com.
authors.forename: Alireza
authors.initials: A
authors.lastname: Abdolrasouli
authors.affiliation: Department of Medical Microbiology, 4th Floor East Wing Laboratory Block, Charing Cross Hospital, Imperial College Healthcare NHS Trust, Fulham Palace Road, London, W6 8RF, UK.
authors.forename: Ximena
authors.initials: X
authors.lastname: Gonzalo
authors.affiliation: Department of Plastic Surgery, Chelsea and Westminster Hospital, Chelsea and Westminster NHS Foundation Trust, London, UK.
authors.forename: Anita
authors.initials: A
authors.lastname: Jatan
authors.affiliation: Department of Plastic Surgery, Chelsea and Westminster Hospital, Chelsea and Westminster NHS Foundation Trust, London, UK.
authors.forename: Gordon J
authors.initials: GJ
authors.lastname: McArthur
authors.affiliation: Department of Pathology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Francis
authors.affiliation: Department of Medical Microbiology, 4th Floor East Wing Laboratory Block, Charing Cross Hospital, Imperial College Healthcare NHS Trust, Fulham Palace Road, London, W6 8RF, UK.
authors.forename: Berge S
authors.initials: BS
authors.lastname: Azadian
authors.affiliation: National Mycology Reference Laboratory and National Collection of Pathogenic Fungi, Public Health England, Bristol, UK.
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Borman
authors.affiliation: National Mycology Reference Laboratory and National Collection of Pathogenic Fungi, Public Health England, Bristol, UK.
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Johnson
mesh_terms: D000369:Aged, 80 and over; D000935:Antifungal Agents / Q000494:pharmacology / Q000627:therapeutic use; D001203:Ascomycota / Q000302:isolation & purification*; D002406:Catheterization, Peripheral / Q000009:adverse effects; D003560:Cysts / Q000209:etiology* / Q000382:microbiology / Q000473:pathology*; D004271:DNA, Fungal / Q000737:chemistry / Q000235:genetics; D004275:DNA, Ribosomal / Q000737:chemistry / Q000235:genetics; D021903:DNA, Ribosomal Spacer / Q000737:chemistry / Q000235:genetics; D003646:Debridement; D006225:Hand / Q000382:microbiology / Q000473:pathology; D006651:Histocytochemistry; D006801:Humans; D016867:Immunocompromised Host; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use; D008297:Male; D008826:Microbial Sensitivity Tests; D008853:Microscopy; D060446:Phaeohyphomycosis / Q000175:diagnosis* / Q000473:pathology*; D011239:Prednisolone / Q000009:adverse effects / Q000627:therapeutic use; D012339:RNA, Ribosomal, 28S / Q000235:genetics; D012507:Sarcoidosis / Q000188:drug therapy; D017422:Sequence Analysis, DNA
chemical_list: D000935:Antifungal Agents; D004271:DNA, Fungal; D004275:DNA, Ribosomal; D021903:DNA, Ribosomal Spacer; D007166:Immunosuppressive Agents; D012339:RNA, Ribosomal, 28S; D011239:Prednisolone
keywords: Antifungal susceptibility testing; Medicopsis romeroi; Mycoses; Phaeohyphomycoses; Subcutaneous cyst