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CASE REPORT
Year : 1990  |  Volume : 56  |  Issue : 6  |  Page : 452-453

Possible lymphatic spread of pheomycotic subcutaneous cysts




Correspondence Address:
N L Sharma


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  Abstract 

A patient who developed: multiple subcutaneous pheomycotic cysts three months after an injury, revealed a growth of Phialpoh4ra gougerotii on culture. lesions showed a lymphatic spread along the forearm, a feature undocumented in this disease.


Keywords: Subcutaneous phaeomycotic cysts, Phialophora gougerotii


How to cite this article:
Sharma N L, Sharma R C, Gupta M L, Singh P. Possible lymphatic spread of pheomycotic subcutaneous cysts. Indian J Dermatol Venereol Leprol 1990;56:452-3

How to cite this URL:
Sharma N L, Sharma R C, Gupta M L, Singh P. Possible lymphatic spread of pheomycotic subcutaneous cysts. Indian J Dermatol Venereol Leprol [serial online] 1990 [cited 2020 Aug 10];56:452-3. Available from: http://www.ijdvl.com/text.asp?1990/56/6/452/3601


Mycotic subcutaneous, intramuscular or osseous cysts are produced by Phialophora gougerotii, P. richardsiae, P. spinifera, Exophiala jeanselmei and Wangiella dermatidis[1],[2] Infection occurs mostly by accidental implantation of fungus on the traumatized skin but often the mode of entry remains obscure. These mycotic cysts are usually single but if multiple they do not show a lymphatic spread.[3] The condition is quite rare; to our knowledge only two cases of an allied entity - phaeohyphomycosis have been reported from India.[4],[5]

We are reporting a patient in whom and injury was followed by the development of multiple phaeomycotic cysts suggesting a lymphatic spread.


  Case Report Top


A 22-year-old lady had a fall and got injured in the left wrist with a broken piece of bangle. The injury healed in a week's time, but after about three months she developed multiple swellings on the outer aspect of her forearm. She applied some indigenous medicine which resulted in ulceration of two of the cysts.

Examination revealed seven cystic swellings arranged in a spiral row, from the dorsum of the wrist through the lateral aspect of the forearm to the medial epicondyle. The skin overlying these cysts was slightly thin and shiny and the area around showed post­inflammatory hyperpigmentation. Two ulcers each of about 1 cm in diameter surmounted by yellowish brown crusts were present on the anterior one third of the forearm. A single epitrochlear lymph node was enlarged.

The routine haemogram and urinalysis were normal. Pus culture for pyogenic organisms from the floor of the ulcer was sterile. A provisional diagnosis of sporotrichosis was made and the tissue was sent for fungus culture and histopathological examination. She was started on potassium iodide solution, to which there was no response in three weeks time. Biopsy was non-contributory while the culture on Sabouraud's medium showed a growth of Phialophora gougerotii. The cysts were excised and the wounds healed completely. Culture from the excised tissue again showed growth of the same fungus.


  Comments Top


Dematiaceous fungi have a worldwide distribution. These fungi are found as saprophytes on wood, wood products and soil, and may produce disease in persons exposed to such environment. Our patient hailed from a town situated amidst thick forests having climatic conditions suitable for the growth of fungi. In pheomycosis an early localisation of the disease occurs by cyst formation. Lymphatic spread of this fungus in such lesions has not yet been documented. However, in the present patient multiple lesions developed in a linear fashion starting from the site of injury upto the regional lymph nodes. This pattern is very much suggestive of lymphatic spread as is seen in sporotrichosis.

 
  References Top

1.Conant NF, Smith DT, Baher RD et al : Infection by dematiaceous fungi, in : Manual of Clinical Mycology, 3rd ed, WB Saunders Company, Philadelphia, 1971; pp 527-532.  Back to cited text no. 1    
2.Allen HB and Rippon JW : Superficial and deep mycoses, in : Dermatology, 2nd ed, Editors Pillsbury SL and Hurley H.J : WB Saunders Company, Philadelphia, 1985; pp 779-780.  Back to cited text no. 2    
3.Roberts SOB and Mackenzie DWR : Mycology, in : Textbook of Dermatology, 2nd ed, Editors Rook A, Wilkinson DS, Ebling FJG : Blackwell Scientific Publications, Oxford, 1979; p861.  Back to cited text no. 3    
4.Amma SM, Panicker CKJ, type PT et al Phaeohyphomycosis caused by Cladosporium bantianum in Kerala (India), Sabouraudia, 1979; 17:419-423.  Back to cited text no. 4    
5.Prabhaker Y, Rao RS, Sharma S et al : A rare case of phaeohyphomycosis caused by Exophiala jeanselmei, Ind J Dermatol Venereol Leprol, 1983; 49 : 17-19.  Back to cited text no. 5    



This article has been cited by
1 Subcutaneous pheohyphomycosis in India - A case report and review
Sharma, N.L., Mahajan, V., Sharma, R.C., Sharma, A.
International Journal of Dermatology. 2002; 41(1): 16-20
[Pubmed]



 

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