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Human Cutaneous Protothecosis: A Case Report and Review of Cases from Mainland China, Hong Kong, and Taiwan

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Abstract

We present a case of cutaneous protothecosis caused by Prototheca wickerhamii infection. The patient was a 72-year-old man with hypoalbuminemia. He responded well to fluconazole treatment. We reviewed this case along with 17 other cases of cutaneous protothecosis reported from mainland China, Hong Kong, and Taiwan. Of the 18 cases, 7 each occurred in mainland China and Taiwan, and 4 occurred in Hong Kong. Thirteen cases were caused by P. wickerhamii (72.2%), and three were caused by P. zopfii (16.7%); in two cases, the species was not identified (11.1%). In all, 9 (50%) patients were immunocompromised, and 10 (55.5%) patients denied having a history of trauma. All patients presented with polymorphic skin lesions, and erythematous papules, plaques, or nodules was the most common presentation (15/18, 83.3%). Genotyping was performed in five cases, mostly by means of small subunit ribosomal DNA amplification (four cases). Susceptibility tests (6 patients) showed that P. wickerhamii was sensitive to amphotericin B and voriconazole but resistant to fluconazole or itraconazole. Treatment succeeded in 15 (83.3%) patients and failed in 3 (16.7%). Our data indicate that the number of cutaneous protothecosis cases is underestimated in China, and the skin lesions have some diagnostic value.

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Acknowledgements

We thank Meirong Li from the dermatology department of the Third Affiliated Hospital, Sun Yat-sen University, for the participation in the mycological tests for the presented patient. We also thank Wanzhen Yu from Taiwan Eden Social Welfare Foundation for her help in the literature search.

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Author notes

  1. Fang Wang and Peiying Feng have contributed equally to this work.

Authors and Affiliations

  1. Department of Dermatology, The First Affiliated Hospital, Sun Yat-sen University, No. 58, Zhongshan Er Road, Guangzhou, 510080, China

    Fang Wang, Xiaohong Chen, Dandan Xu & Jiande Han

  2. Department of Dermatology, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510630, China

    Peiying Feng

  3. Department of Chinese Traditional Medicine, The Eastern Hospital of the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510700, China

    Yimin Lin

  4. Department of Pathology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, China

    Zhuo Wang

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  1. Fang Wang
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Correspondence to Jiande Han.

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All authors declare that they have no conflicts of interest pertaining to this work.

Ethical Approval

The study was approved by the ethics committee of the First Affiliated Hospital of Sun Yat-sen University.

Informed Consent

Informed consent was obtained from the patient reported in the study.

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Handling editor: Patrick CY Woo.

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Wang, F., Feng, P., Lin, Y. et al. Human Cutaneous Protothecosis: A Case Report and Review of Cases from Mainland China, Hong Kong, and Taiwan. Mycopathologia 183, 821–828 (2018). https://doi.org/10.1007/s11046-018-0292-3

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  • DOI: https://doi.org/10.1007/s11046-018-0292-3

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