ISSN:
1365-4632
Source:
Blackwell Publishing Journal Backfiles 1879-2005
Topics:
Medicine
Notes:
A 67-year-old Japanese man had been treated occasionally for asthma by oral administration of prednisolone at a dose between 5 and 15 mg/day for 18 years. In December 1993, the patient had a severe asthma attack, during which he developed a pneumothorax, complicated by pneumonia. He was hospitalized immediately, and antibiotics and hydrocortisone were administered intravenously. The treatment was, however, ineffective and his condition deteriorated. In February 1994, he was treated with pulse therapy of 1 g/day of sodium hydrocortisone for 3 days. During the pulse therapy, erythema and red papules were noticed on his right dorsum manus. The erythema progressed with purpura, induration, and local fever. The papules became necrotic, giving rise to small ulcers with effusions (Fig. 1). The patient also developed a subcutaneous nodule on the proximal region of his forearm.Laboratory investigations revealed anemia (hemoglobin (Hb), 9.6 g/dL), leucocytosis (leukocyte count, 11,800/mm3), slight liver dysfunction (GOT 32KU, GPT 71KU, LDH 759UU), and hypoaluminemia (albumin (Alb), 2.7 mg/dL). A biopsy of the indurated erythema of the dorsum manus was performed.The histopathology of the biopsied tissue showed diffuse infiltration with inflammatory cells, edema, and necrosis in the mid-dermis and fat. The infiltrate consisted of lymphocytes, neutrophils, histiocytes, and occasional giant cells. Many mycelial form fungal elements were observed (Fig. 2a), and aggregates of hyphae were also found in the lower dermis (Fig. 2b). Similar findings were noted for the biopsied specimen of the forearm subcutaneous nodule.Biopsied material was inoculated on Sabouraud's dextrose agar, and floccose and smoky-gray colonies grew rapidly at room temperature for 7 days (Fig. 3a). Microscopic findings showed that the hyphae were broad, branching, and brown in color. Round or oval conidia were produced singly on short conidiophores from the sides of the hyphae, or terminally on long conidiophores (Fig. 3b). Scanning electron microscopy showed an oval conidium produced from the terminus of the conidiophore with annellation. Although we observed the cultured mycelium for several months, cleistothecia were not produced. From these findings, we identified the organism as Scedosporium apiospermum, the asexual stage of Pseudallescheria boydii. The organism was not isolated from sputum or blood cultures.The patient was given fluconazole intravenously at 400 mg/day. Although the treatment was stopped after 2 weeks, because of increasing serum transaminase, the erythema and subcutaneous nodule almost completely disappeared after 5 weeks.
Type of Medium:
Electronic Resource
URL:
http://dx.doi.org/10.1046/j.1365-4362.1997.00287.x
Permalink
