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Severe Disseminated Phaeohyphomycosis in an Immunocompetent Patient Caused by Veronaea botryosa

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Abstract

We present a severe case of disseminated phaeohyphomycosis due to Veronaea botryosa. A 32-year-old female, native from Cuautla, Morelos, Mexico, presented a chronic dermatosis which started 10 years earlier with multiple exophytic, multilobulated, soft, and pedunculated or sessile neoformations of diverse sizes from 2 to 10 cm in diameter, which became verrucose and increased in size. The patient was immunocompetent, and no hereditary or familiar precedents of importance were known. No treatment was given, and the dermatosis remained relatively stable until the patient became pregnant in 2001 and 2003. The infection then exacerbated and worsened, leading to dissemination to the extremities, trunk, and face. The initial diagnosis was chromoblastomycosis which was treated with terbinafine and itraconazole but without visible improvement. Histopathology revealed pigmented, irregular, unbranched, and septate hyphae. Veronaea botryosa was isolated (CBS 127264 = JX566723), and its identity was confirmed by sequencing the internal transcribed spacer (ITS) rDNA. Therapy with posaconazole (800 mg/day) was started showing a gradual improvement of lesions with a reduction in size and flattening of the eruptions.

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Acknowledgments

This study and the work of H. Badali were supported by a grant from the School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran. We thank Francesco Lavino for his valuable help with the antifungal treatment of our patient.

Conflict of interest

J.F.M. received grants form Astellas, Basilea, Merck, and Schering-Plough. He has been a consultant to Basilea and Merck and received speaker’s fees from Gilead, Janssen Pharmaceutica, Merck, Pfizer, and Schering-Plough. All other authors: No potential conflicts of interest. The authors alone are responsible for the content and writing of the paper.

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Correspondence to Hamid Badali.

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Bonifaz, A., Mohammad Davoudi, M., de Hoog, G.S. et al. Severe Disseminated Phaeohyphomycosis in an Immunocompetent Patient Caused by Veronaea botryosa . Mycopathologia 175, 497–503 (2013). https://doi.org/10.1007/s11046-013-9632-5

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