Phialemonium curvatum infection after bone marrow transplantation

• Main Authors: HEINS-VACCARI Elisabeth Maria, MACHADO Clarisse M., SABOYA Rosaura S., SILVA Roberto L., DULLEY Frederico L., LACAZ Carlos da S., FREITAS LEITE Roseli S. de, HERNANDEZ ARRIAGADA Giovana L.
• Format: Article in Journal/Newspaper
• Language: English
• Published: Universidade de São Paulo (USP) 2001
• Subjects: Phialemonium curvatum; Bone marrow transplantation; Phaeohyphomycosis; Hyalohyphomycosis; Arctic medicine. Tropical medicine; RC955-962; Infectious and parasitic diseases; RC109-216; Arctic
• Online Access: https://doaj.org/article/53ae7d370eb44dd3b0e696d4146b034d

We report a case of cutaneous infection caused by Phialemonium curvatum GAMS et COOKE, 1983, after bone marrow transplantation. The genus Phialemonium was created by GAMS & MCGINNIS in 1983 including three new species: Ph. obovatum, Ph. curvatum and Ph. dimorphosporum, and represents an intermediate genus between Acremonium and Phialophora. Nowadays, the genus Phialemonium is considered to be a pheoid fungus which may cause the eventual lesions observed in pheo- and hyalohyphomycosis. Species of this genus have been described as opportunistic agents in humans and animals, mainly as a result of immunosuppression. In the present case, the patient had multiple myeloma and received an allogenic bone marrow transplant from his HLA-compatible brother. Two months after transplantation, he developed purplish and painful nodular lesions on the right ankle. Some of these lesions drained spontaneously and apparently hyaline mycelial filaments were observed, whose culture was initially identified as Acremonium sp. Subsequent studies showed that the fungus was Phialemonium curvatum. The infection was treated with amphotericin B, followed by ketoconazole. The patient was submitted to surgical debridement followed by two skin grafts to repair the bloody area. The duration of the treatment was 4 months and secondary prophylaxis with ketoconazole alone was maintained for one additional month. No recurrence was observed after discontinuation of treatment. The authors comment on the pathogenicity of the genus Phialemonium.