A 7-year-old boy presented with kerion-like inflammatory alopecia. Direct microscopy demonstrated fungal hyphae, and a cultured mould was reported as Aspergillus lentulus by mass spectrometry. Treatment comprised oral terbinafine for 3 months and oral prednisone for 2 months. Fungal examination was negative and Wood lamp examination was normal at 3 months; hair regrowth was gradually recovering at the 6-month follow-up. This case illustrates the need to interpret an unusual mould isolate alongside clinical findings before assigning causation.
Prostatic coccidioidomycosis is an exceptionally rare manifestation of disseminated infection. A 48-year-old man with diabetes and prior pulmonary coccidioidomycosis developed recurrent cavitary pneumonia and urinary retention. Prostate biopsy demonstrated lymphogranulomatous inflammation and fungal spherules. Serial complement-fixation titers ranged from 1:64 to 1:128. Coccidioides was not isolated in culture; therefore, species-level identification was not possible. Approximately 9 months after prostate biopsy, the patient was voiding independently while receiving chronic fluconazole 400 mg daily. This case emphasizes prolonged suppressive therapy, serologic monitoring, and distinction between coccidioidal prostatitis and blastomycosis.
We describe the case of a 57-year-old female with chronic hoarseness and cough whose laryngeal exam revealed chronic laryngitis with exudates. She failed multiple courses of fluconazole for presumed laryngeal candidiasis. Pathology demonstrated laryngeal cryptococcosis, and sputum cultures grew Cryptococcus neoformans with an elevated fluconazole MIC. Immunological evaluation led to the diagnosis of common variable immunodeficiency. After complications with alternative antifungals, the patient responded favorably to isavuconazole and intravenous immunoglobulin replacement.
Wickerhamiella pararugosa , a rare cause of bloodstream infection, was identified in an 87-year-old woman admitted to a Hospital-at-Home unit for a complicated urinary tract infection, without a central venous catheter. Empirical micafungin was switched to rezafungin, a long-acting echinocandin, enabling HaH-based completion of therapy. Work-up revealed Takotsubo syndrome, managed without disrupting antifungal treatment. This is the first reported HaH management of this species and the first use of rezafungin for W. pararugosa infection.
