We here describe the case of a kidney transplant patient from Mali who presented with multiple complex seizures followed by a facial paresis revealing a brain abscess due to Nannizziopsis obscura species complex. This fungal species is usually implicated in reptile skin infections and rarely disseminated infections. Very rarely, it can infect human beings suffering from immunodepression, causing various kinds of complications ranging from soft tissue abscesses to solid organ abscesses. This case highlights the potential wide range of pathogens involved and underlines the need for greater vigilance in the diagnosis and management of atypical infections in transplant settings.
A 46-year-old woman from Colombia, without any medical comorbidities, presented with marked yellowish discoloration of both big toenails, suggestive of onychomycosis, and malalignment of the nail plate. Culture of nail scrapings grew dark-pigmented, mucoid, yeast-like colonies identified as Exophiala alcalophila by ITS sequencing. Broth microdilution identified the isolate as resistant to fluconazole and the echinocandins. The patient refused antifungal treatment. This case highlights the importance of black yeast-like fungi as etiological agents of onychomycosis.
This report describes a case of primary cutaneous mucormycosis in a patient with Hailey-Hailey Disease (benign familial pemphigus). The diagnosis of primary cutaneous mucormycosis was confirmed via microbiological culture as well as histopathology. Our patient improved with prompt surgical debridement and excision of infected, necrotic tissue with complementary antifungal therapy. To the best of our knowledge this is the first reported case of cutaneous mucormycosis in a patient with Hailey-Hailey Disease and contributes to the literature regarding pathophysiology, management and treatment for each of these rare entities.
This report describes a case of primary cutaneous mucormycosis in a patient with Hailey-Hailey Disease (benign familial pemphigus). The diagnosis of primary cutaneous mucormycosis was confirmed via microbiological culture as well as histopathology. Our patient improved with prompt surgical debridement and excision of infected, necrotic tissue with complementary antifungal therapy. To the best of our knowledge this is the first reported case of cutaneous mucormycosis in a patient with Hailey-Hailey Disease and contributes to the literature regarding pathophysiology, management and treatment for each of these rare entities.
Background Onychomycosis is one of the most common nail disorders worldwide and is predominantly caused by dermatophytes; however, infections caused by non-dermatophyte molds are increasingly recognized as important causes of nail disease. Case presentation We present a case of a 41-year-old male from Duhok, Iraq, with a 15-year history of Crohn’s Disease. He presented with progressive discoloration, nail thickening, nail deformity, pain while walking and brittleness of the affected nail that had persisted for several months. He was diagnosed with onychomycosis due to Syncephalastrum species, confirmed by KOH microscopy and characteristic culture morphology. Molecular confirmation was not available to identify to the species level. The fungus was sensitive to itraconazole, nystatin, clotrimazole, amphotericin B, miconazole, and ketoconazole, but showed resistance to fluconazole and voriconazole. He was successfully treated using IV amphotericin B, topical clotrimazole, and nail surgery. Conclusions This case demonstrates that Syncephalastrum species can cause clinically significant onychomycosis and should not automatically be dismissed as laboratory contaminants. A combination of clinical assessment, direct microscopy, culture-based identification, and antifungal susceptibility testing is essential for establishing diagnosis and guiding appropriate management.
COVID-19-associated pulmonary aspergillosis (CAPA) is typically described in critically ill patients with severe pneumonia. We report a 68-year-old man, 16 weeks post autologous hematopoietic stem cell transplant for AL amyloidosis, who developed invasive pulmonary aspergillosis (IPA) following mild COVID-19 upper respiratory tract infection not requiring oxygen supplementation or ICU admission. Diagnosis was established by positive broncho-alveolar lavage galactomannan with compatible CT chest findings, and he was treated with oral voriconazole. This case highlights that IPA may complicate mild COVID-19 in patients not traditionally considered at highest risk, supporting the concept that cumulative risk factors may precipitate IPA.
Background Rhinocladiella mackenziei is a rare neurotropic dematiaceous fungus that causes cerebral phaeohyphomycosis, predominantly in immunocompetent adults with a geographical predilection to the Middle East. Pediatric infection is exceptionally rare, and to our knowledge, no cases of combined osseous and central nervous system involvement following hematopoietic stem cell transplantation (HSCT) have been reported. Case We report a male child with autosomal recessive chronic granulomatous disease (CGD) who developed traumatic forearm osteomyelitis due to R. mackenziei several months after haploidentical HSCT. Subsequent neuroimaging demonstrated intracerebral abscesses despite immune reconstitution. The infection persisted despite prolonged combination antifungal therapy with voriconazole and amphotericin B and ultimately required neurosurgical excision. The patient recovered without neurological sequelae and continues on long-term posaconazole therapy. Conclusion This case highlights R. mackenziei as a cause of severe, invasive, disseminated fungal disease in pediatric post-bone marrow transplant patients and demonstrates extracerebral inoculation with subsequent CNS dissemination. It also underscores the importance of early recognition and a combined medical-surgical approach in management of refractory disease.
This report describes a molecularly confirmed case of canine dermatophytosis caused by Arthroderma uncinatum in an 11-month-old English Setter from Southern Italy. The dog presented with two alopecic, erythematous, scaling lesions on the metacarpal and metatarsal regions. While routine microscopic examinations were inconclusive, dermatophyte culture yielded a fungal isolate identified as A. uncinatum by ITS sequencing. Topical 1% clotrimazole administered for three weeks resulted in complete clinical and mycological cure. This case documents an uncommon infection by a geophilic dermatophyte and expands veterinary knowledge of A. uncinatum-associated canine disease.
Sporotrichoid distribution is classically associated with Sporothrix schenckii, yet Candida parapsilosis remains an exceedingly rare cause. We report a primary cutaneous C. parapsilosis infection presenting with lymphocutaneous spread. The patient achieved significant clinical improvement following oral fluconazole. This case expands the recognized clinical spectrum of C. parapsilosis and underscores the necessity of fungal culture in the differential diagnosis of sporotrichoid spreading lesions to ensure prompt, targeted antifungal therapy.
Cyberlindnera fabianii is a rare opportunistic yeast increasingly recognized as a cause of invasive infections. We report two fatal cases of C. fabianii fungemia in elderly patients with multiple comorbidities. Microbiological analysis revealed low minimum inhibitory concentrations (MICs) to amphotericin B and echinocandins, but variable susceptibility to fluconazole. One patient received antifungal therapy with limited response; in the second case, the pathogen was identified postmortem.
Cryptococcus is an opportunistic fungal pathogen found in immunocompromised patient such as HIV or transplant recipients. Infection of central nervous system is the most common manifestation but pulmonary and skeletal involvement have been reported in non-HIV population. We report a case of cryptococcal otomastoiditis which was extremely rare and majority of cases were reported in individual without comorbidity. In this case, we also identified adult-onset immunodeficiency associated with interferon-gamma autoantibodies in this patient as an important underlying which predisposed cryptococcal infection.
Seborrheic dermatitis (SD) is a chronic inflammatory skin condition likely caused by several factors, including overgrowth of the lipophilic yeast Malassezia, increased sebaceous gland activity, and a potential genetic predisposition, whereas Malassezia folliculitis (MF) is a fungal infection of hair follicles. In this case, a 22-year-old male initially presented with erythematous papules on the malar region and was clinically diagnosed with SD. Following partial improvement with topical and oral antifungals, the patient developed new pustular lesions involving the malar and chin regions, raising suspicion of MF. The absence of comedones and cysts helped rule out Acne vulgaris. Potassium hydroxide mount from pustular swabs revealed numerous fungal spores, prompting further investigation. Culture on modified Leeming and Notman agar yielded yeast colonies, which appeared as budding yeast cells under light and fluorescence microscopy with Calcofluor white stain. Molecular identification using PCR for the ITS regions and RFLP analysis confirmed the isolate as Malassezia furfur. This case highlights the clinical progression from SD to MF, underscoring the pathogenic potential of Malassezia and the importance of integrating clinical, microscopic, and culture-based molecular diagnostic approaches for accurate diagnosis and targeted treatment in dermatological mycoses.
Fungal peritonitis is a severe complication of peritoneal dialysis (PD), increasingly involving rare yeasts that challenge routine diagnostics. We report PD-associated peritonitis caused by Blastobotrys adeninivorans, initially misidentified as Candida ciferrii by automated platforms (VITEK 2 and MALDI-TOF MS). Persistent neutrophilic inflammation and elevated effluent β-D-glucan prompted multilocus sequencing, which confirmed B. adeninivorans. Susceptibility testing showed markedly elevated MICs to amphotericin B, azoles, and echinocandins, interpreted cautiously because validated breakpoints are unavailable. This case illustrates how persistent culture-positive PD peritonitis with discordant or unusual yeast identification should prompt molecular confirmation. Clinical resolution followed PD catheter removal and transition to haemodialysis, underscoring the importance of early source control in refractory PD-associated fungal peritonitis.
Antifungal treatment of invasive fungal infections (IFI) in immunocompromised children is challenging. We present a case of rhinocerebral and pulmonary IFI caused by Mucor nidicola and Aspergillus calidoustus with limited azole susceptibility successfully treated with MAT2203 after developing toxicity from intravenous liposomal amphotericin B.
Disseminated phaeohyphomycosis can have severe consequences in immunocompromised hosts, and does not have standardized therapeutic protocols. A 68-year-old man with prior renal transplant presented with nodular pneumonia. Symptoms worsened despite empiric antimicrobials, including isavuconazole for antifungal coverage. After new T2-enhancing lesions were seen on MRI brain along with worsened pulmonary and soft tissue lesions, transbronchial biopsy revealed disseminated Verruconis gallopava as the inciting pathogen. Therapy was successfully narrowed to posaconazole based on sensitivities. Future literature should evaluate the most optimal first-line therapy for Verruconis, due to the high morbidity and mortality seen in disseminated disease.
Cutaneous candidiasis typically affects intertriginous areas and may be overlooked when occurring at non-intertriginous sites. We report a 28-year-old otherwise healthy man with a 7-month history of pruritic scaly erythematous lesions on both upper extremities and the upper abdomen. Before presentation, he had used a topical corticosteroid unsupervised for 2 months. The lesions were initially treated as tinea corporis. Direct microscopy showed pseudohyphae and spores, and two consecutive fungal cultures yielded Candida spp., with CHROMagar Candida supporting Candida albicans. The lesions resolved completely within 2 weeks after oral itraconazole and topical ciclopirox olamine. This case highlights the importance of mycological confirmation in chronic scaly eruptions with unusual distribution, especially in the setting of prior topical corticosteroid exposure.
We report a rare case of disseminated paracoccidioidomycosis in an immunocompetent 41-year-old woman presenting with granulomatous skin lesions, neurological involvement, and subretinal fibrosis leading to exudative retinal detachment and permanent vision loss. Diagnosis was confirmed by direct microscopy, histopathology, and serology. The patient was treated with liposomal amphotericin B followed by trimethoprim-sulfamethoxazole, showing significant clinical improvement. This case highlights an atypical presentation of paracoccidioidomycosis with ocular and central nervous system involvement, emphasizing the need to consider the disease in differential diagnoses even in unusual forms, especially in endemic regions.
Paracoccidioidomycosis (PCM) rarely involves the spine. We report a 55-year-old man with disseminated PCM presenting with thoracic spinal cord compression and an unprecedented pulmonary-spine fistula identified intraoperatively. Diagnosis was confirmed by histopathology and mycology. The patient underwent surgical decompression and stabilization followed by itraconazole, achieving complete neurological recovery. This case highlights a unique complication of PCM and supports combined surgical and antifungal management in cases with neurological compromise.
We report Exophiala dermatitidis keratitis developing one year following cataract surgery in a 73-year-old immunocompetent man. Before the correct diagnosis was established, the patient was initially treated for suspected epithelial ingrowth with corticosteroids for ten months. Therapeutic penetrating keratoplasty was required, despite intensive antifungal therapy including topical and systemic voriconazole and amphotericin B. This case underscores the criticality of considering fungal infection in atypical postoperative presentations with prolonged corticosteroid exposure.
Histoplasma capsulatum is a pathogenic fungus known to exist across the world, especially in the Ohio and Mississippi River Valleys. While clinicians commonly rely on urine and serum Histoplasma antigen testing for rapid detection of disseminated Histoplasmosis, these diagnostic tests have limitations. We present a case of a patient who initially had negative urine and serum Histoplasma antigen tests and required additional testing with lymph node biopsy and immunodiffusion to establish a diagnosis of histoplasmosis. This case highlights the importance of employing multiple testing methods when there is strong clinical suspicion for Histoplasmosis.
