Deep Dermal Fungal Infections in Patients That Are Immunosuppressed.
Laura J Adhikari, Glenn D Roberts, Michael J Camilleri. Mayo Clinic, Rochester, MN
Background: Most clinicians use acute and granulomatous inflammation as a threshold for suspicion of an infectious organism. In immunosuppressed patients that are unable to mount an adequate immune response it has been postulated that the threshold for suspicion should be much lower. Over the years few journal articles have been published on characterizing fungal infections of the skin and the presentation in immunosuppressed patients. Most of these publications are case reports on opportunistic fungi such as Fusarium, melanized fungi, and Cryptococcus. Our goal is to look at a population of immunosuppressed patients and characterize the leading pathogens and compare the findings to those of immunocompetent patients in the literature.
Design: All the patients were selected from the Mayo database over the past 10 years. The inclusion criteria were that all patients will have had to have had a fungal infection of the skin that has been biopsied and also had a positive fungal culture. These patients will also have any kind of history that would lead to immunosuppression, whether it be by transplantation, treatment for an autoimmune condition, lymphoma, congenital/acquired immune condition, ect. All of the cases had a GMS (Grocott's Methanamine Silver) and/or PAS stain performed.
Results: Our initial results show that among 7 patients, Alternaria sp. was the most common organism affecting 3 patients. The remaining 4 patients were infected by Exophilia jeanselmei, Scedosporium apoispermum, Fusarium sp., and Aspergillus sp. A variety of host responses were observed ranging from a suppurative granulomatous response to a paucicellular immune response and mycetoma formation. The clinical presentations were predominantly nontender nodules that were biopsied to rule out carcinoma.
Conclusions: One of these patients had a large deep dermal nodular area with paucicellular lymphocytic infiltrate and necrotic debris that could be mistaken as infarct. Due to the patient's history, a GMS stain was ordered which revealed the entire area to be mycetoma which was initially very difficult to descern on H&E. This scenario could represent another diagnostic pitfall should there be low clinical suspicion.
Wednesday, March 2, 2011 1:00 PM
Poster Session VI # 128, Wednesday Afternoon