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Volume 25, Number 9—September 2019
Research Letter

Parathyridaria percutanea and Subcutaneous Phaeohyphomycosis

Shivaprakash M. Rudramurthy1, Megha Sharma1, Nandini Sethuraman, Pinaki Dutta, Bansidhar Tarai, Jayanthi Savio, Amanjit Bal, Usha Kalawat, and Arunaloke ChakrabartiComments to Author 
Author affiliations: Postgraduate Institute of Medical Education and Research, Chandigarh, India (S.M. Rudramurthy, M. Sharma, N. Sethuraman, P. Dutta, A. Bal, A. Chakrabarti); Apollo Hospitals, Chennai, India (N. Sethuraman); Max Super Speciality Hospitals, New Delhi, India (B. Tarai); St. Johns Medical College and Research Institute, Bengaluru, India (J. Savio); Sri Venkateshwara Institute of Medical Sciences, Tirupati, India (U. Kalawat)

Main Article

Table

Comparison of demographic, clinical, and microbiological features of subcutaneous phaeohyphomycosis due to Parathyridaria percutanea

Case no.
 Study or
isolate ID
 Age, y/
sex
 Residing country;
native country
 Risk factor
(time since)
 Site
 Diagnostic modality
 Molecular targets
 GenBank accession nos., ITS/28S
 AFST
 Treatment
 Outcome
Previously reported
1 (5)† 63/M The Netherlands;
Aruba, Caribbean Renal tx (2 y) Rt lateral foot Culture Misidentified as M. mycetomatis ITS KF322118/ KF366449 Low MIC to VR, PS, IT† Multiple aspiration of pus + surgical excision Healed,
no recurrence
2 (2) 45/M United States;
India None; tattoo on the site‡ (2 y); DM Lt lateral foot and ankle Culture ITS KF322117/ KF366448 Low MIC to VR, PS, IT Azole therapy for 4 mo + surgical excision§ LTFU
3 (6) 65/M France;
Congo Renal tx (1 y) Lt lateral malleoli HPE;
No culture sent NA¶ NA ND PS + surgical excision ND
4 (7) 55/F Germany;
Somalia Renal and pancreatic tx (3 y) Lt knee synovial bursitis GMS staining and culture ITS NA Low MIC to azole VR, PS, IT VR for 1 mo + surgical excision Healed,
No recurrence
5
 (8)
 47/M
 United Kingdom;
India
 Renal tx (1.5 y)
 Rt Achilles
 Calcofluor and PAS stain
 ITS, 28S
 NA
 ND
 VR for 2 weeks + surgical excision
 Healed.
No recurrence
Reported in this study
6 NCCPF 104001
(index case) 35/M India (Chandigarh);
India ACTH-dependent Cushing’s syndrome Lt forearm and axilla KOH, Calcofluor and culture ITS, 28S MG708109/
MG708116 NCO None LTFU
7 NCCPF
104003; (4)# 47/M India (Andhra Pradesh);
India Post–renal transplant Great toe KOH and culture ITS, 28S MG708107/
MG708115 NCO VR Healed,
no recurrence
8 NCCPF
104004 54/F India (Delhi);
India Interstitial lung disease on steroids Elbow, knee KOH and culture ITS, 28S MG708106/
MG708114 NCO Surgical excision and VR Healed,
no recurrence
9 NCCPF
104005 45/M India (Andhra Pradesh);
India Post–renal transplant Foot KOH and culture ITS, 28S MG708105/
MG708113 NCO None LTFU
10 NCCPF
104006 50/M India (Bangalore);
India Post–renal transplant Rt foot KOH and culture ITS, 28S MG708108/NA NCO None LTFU

*AFST, antifungal susceptibility testing; DM, diabetes mellitus; GMS, Grocott methenamine silver; HPE, histopathological examination; IT, itraconazole; ITS, internal transcribed spacer; Lt, left; LTFU, lost to follow-up; MIC, minimal inhibitory concentration; NA, not applicable; NCCPF, National Culture Collection for Pathogenic Fungi; NCO, not carried out; ND, not documented; PAS, periodic acid–Schiff; PS, posaconazole; Rt, right; Tx, transplant; VR, voriconazole.
†Ahmed et al. (2) studied the culture originally reported by Meis et al (5).
‡Immunocompetent patient with a tattoo at the site of infection; diabetes mellitus was diagnosed incidentally when patient sought care.
§Posaconazole was discontinued (due to gastrointestinal intolerance) and switched to voriconazole, which was also discontinued (due to visual disturbances) and changed to itraconazole.
¶Panfungal PCR done but no targets mentioned (6).
#Case described earlier as an “uncommon black fungus belonging to order Pleosporales” (10) was identified at NCCPF. This case is described again in the study series as P. percutanea.

Main Article

References
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1These first authors contributed equally to this article.

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Page updated: August 21, 2019
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