title: Subcutaneous phaeohyphomycosis caused by Exophiala spinifera in a European patient with lymphoma: a rare occurrence case report and literature review.
abstract: Exophiala spinifera is a dematiaceous fungus responsible for rare skin infections presenting as phaeohyphomycosis or chromoblastomycosis which has been primarily reported in tropical and subtropical areas (Asia, South and North America). We report the first case of E. spinifera phaeohyphomycosis in a European patient. The phaeohyphomycosis was limited to the skin, involving the finger of an immunocompromised patient presenting with a large B-cell lymphoma treated by R-mini-CHOP regimen. Remission was initially achieved by surgical excision; however, a local subcutaneous relapse required treatment with itraconazole. We performed a literature review of the 32 previously published cases of E. spinifera phaeohyphomycosis highlighting its clinical phenotype: disseminated infection with extracutaneous involvement and poor prognosis were reported in young patients, of whom some were recently associated with CARD9 mutations, whereas cases in older immunocompromised patients were limited to the skin and showed better prognosis. There is currently no standard treatment for E. spinifera phaeohyphomycosis; however, itraconazole, alone or in combination, allowed partial or complete response in 16 out of 20 cases.
authors.affiliation: Department of Dermatology, Avicenne Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Bobigny, France. gerome.bohelay@aphp.fr.
authors.forename: G
authors.initials: G
authors.lastname: Bohelay
authors.affiliation: Department of General Practice, University Paris Diderot, Sorbonne Paris Cité, Paris, France.
authors.forename: S
authors.initials: S
authors.lastname: Robert
authors.affiliation: Laboratory of Mycology, Avicenne Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Bobigny, France.
authors.forename: C
authors.initials: C
authors.lastname: Bouges-Michel
authors.affiliation: Department of Internal Medicine, Jean Verdier Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Bondy, France.
authors.forename: M
authors.initials: M
authors.lastname: Gerin
authors.affiliation: Department of Pathology, Avicenne Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Bobigny, France.
authors.forename: A
authors.initials: A
authors.lastname: Levy
authors.affiliation: Department of Internal Medicine, Saint-Antoine Hospital, AP-HP, DHU i2B, University Paris 6, Paris, France.
authors.forename: O
authors.initials: O
authors.lastname: Fain
authors.affiliation: Department of Dermatology, Avicenne Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Bobigny, France.
authors.forename: F
authors.initials: F
authors.lastname: Caux
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000935:Antifungal Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D005093:Exophiala / Q000187:drug effects / Q000302:isolation & purification* / Q000648:ultrastructure; D005385:Fingers / Q000601:surgery; D006801:Humans; D016867:Immunocompromised Host; D017964:Itraconazole / Q000627:therapeutic use; D016393:Lymphoma, B-Cell / Q000150:complications* / Q000188:drug therapy / Q000382:microbiology; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000382:microbiology; D060446:Phaeohyphomycosis / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology*; D012867:Skin / Q000382:microbiology / Q000473:pathology; D055815:Young Adult
chemical_list: D000935:Antifungal Agents; D017964:Itraconazole
keywords: 
  Exophiala
  ; 
  Exophiala spinifera
  ; B-cell lymphoma; phaeohyphomycosis