Abstract
The incidence of candidiasis due to non-albicans Candida species (especially Candida glabrata) has significantly increased in recent decades. Candida glabrata often invades immunocompromised hosts and causes systemic or mucosal infections, whereas cutaneous infections are rarely reported. We present a rare case of cutaneous infection caused by C. glabrata and review all similar cases available in the PubMed database. A patient was admitted to the hospital with a 2-month history of a plaque on the face. Histopathological examination displayed typical infectious granulomas in the deep dermis, and the pathogen was finally confirmed as C. glabrata using a series of microbial examinations (fungal culture, biochemical test, and PCR-directed sequencing). The patient was completely cured after 4 months of treatment with oral itraconazole combined with topical terbinafine. We reviewed similar reports of cutaneous infection caused by C. glabrata. All the data suggested that an accurate diagnosis of cutaneous candidiasis depends mainly on histological and fungal examinations, especially molecular biological assays. Antifungal agents based on microbial susceptibility tests are the first-line treatment choice for C. glabrata infection, but the prognosis might be more dependent on the basic condition of the host.
Similar content being viewed by others
Abbreviations
- PCR:
-
Polymerase chain reaction
- AIDS:
-
Acquired immune deficiency syndrome
- SDA:
-
Sabouraud agar
- H&E:
-
Hematoxylin and eosin
- MIC:
-
Minimal inhibitory concentration
References
Turner SA, Butler G. The Candida pathogenic species complex. Cold Spring Harb Perspect Med. 2014;4(9):a019778.
Fidel PL, Vazquez JA, Sobel JD. Candida glabrata: review of epidemiology, pathogenesis, and clinical disease with comparison to C. albicans. Clin Microbiol Rev. 1999;12(1):80–96.
Kurtzman CP, Robnett CJ. Identification of clinically important ascomycetous yeasts based on nucleotide divergence in the 5’ end of the large-subunit (26S) ribosomal DNA gene. J Clin Microbiol. 1997;35(5):1216–23.
Ellepola AN, Morrison CJ. Laboratory diagnosis of invasive candidiasis. J Microbiol. 2005;43:65–84.
Pfaller MA, Boyken L, Hollis RJ, Messer SA, Tendolkar S, Diekema DJ. In vitro susceptibilities of clinical isolates of Candida species, Cryptococcus neoformans, and Aspergillus species to itraconazole: global survey of 9,359 isolates tested by clinical and laboratory standards institute broth microdilution methods. J Clin Microbiol. 2005;43(8):3807–10.
Celik AD, Yulugkural Z, Kuloglu F, Akata F. Candida glabrata: etiologic agent of soft tissue abscess in a diabetic patient. Indian J Pathol Microbiol. 2010;53(3):590–1.
Gugic D, Cleary T, Vincek V. Candida glabrata infection in gastric carcinoma patient mimicking cutaneous histoplasmosis. Dermatol Online J. 2008;14(2):15.
Shindo M, Yoshida Y, Adachi K, Nakashima K, Watanabe T, Yamamoto O. Necrotizing soft-tissue infection caused by both Candida glabrata and Streptococcus agalactiae. Arch Dermatol. 2009;145(1):96–7.
Loulergue P, Mahe V, Bougnoux ME, Poiree S, Hot A, Lortholary O. Fournier’s gangrene due to Candida glabrata. Med Mycol. 2008;46(2):171–3.
Joshua D, Septimus TS, Fainstein V. Fournier’s Gangrene due to Candida glabrata: case report and review of the literature. Infect Dis Clin Pract. 2002;11(7):406–7.
Demiraslan H, Alabay S, Kilic AU, Borlu M, Doganay M. Cutaneous candidiasis caused by Candida glabrata in a HIV/AIDS patient. Int J STD AIDS. 2013;24(9):753–5.
Silva S, Negri M, Henriques M, Oliveira R, Williams DW, Azeredo J. Candida glabrata, Candida parapsilosis and Candida tropicalis: biology, epidemiology, pathogenicity and antifungal resistance. FEMS Microbiol Rev. 2012;36(2):288–305.
Rodrigues CF, Silva S, Henriques M. Candida glabrata: a review of its features and resistance. Eur J Clin Microbiol Infect Dis. 2014;33(5):673–88.
Acknowledgements
We thank Dr. Huyan Chen at the Department of Dermatology (Huashan Hospital, Fudan University) for the histopathological instruction.
Funding
This study was supported by the Natural Science Foundation of Zhejiang Province (LQ14H190002) and China Postdoctoral Science Foundation Grant (2016M600286).
Authors’ Contributions
YF, WP, GW, YH, YL, WF, and XT contributed substantially to the conception of the study and analysis and interpretation of the data. All authors read and approved the final manuscript.
Author information
Authors and Affiliations
Corresponding authors
Ethics declarations
Conflict of interests
The authors have no conflicts of interest to report.
Ethics Approval
This study was proved by the Committee on Ethics of Biomedicine Research, Zhejiang Provincial People’s Hospital.
Informed Consent
Informed written consent was obtained from the patient prior to publication of the case details.
Rights and permissions
About this article
Cite this article
Fan, Y., Pan, W., Wang, G. et al. Isolated Cutaneous Granuloma Caused by Candida glabrata: A Rare Case Report and Literature Review. Mycopathologia 183, 417–421 (2018). https://doi.org/10.1007/s11046-017-0228-3
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11046-017-0228-3