28714 Primary cutaneous Fusarium infection in an immunocompetent host
Robinson G, Friedman B, and McHargue C. 28714 Primary cutaneous Fusarium infection in an immunocompetent host. J Am Acad Dermatol 2021; 85(3):AB206.
J Am Acad Dermatol
Introduction: Fusarium is a ubiquitous hyalohyphomycete found in the soil and air in many parts of the world. While well recognized as cause of severe disseminated disease in immunocompromised hosts, reports of cutaneous Fusarium infection in immunocompetent hosts are rare.
Clinical case: A 67-year-old immunocompetent African American female with a history of diabetes mellitus complicated by neuropathy (A1c 7.7%) presented with a 2-year history of an asymptomatic nonhealing sore on the dorsal aspect of her left foot. It had begun as a small red papule that subsequently developed peripheral pustules and ulcerated. Examination revealed a firm brawny plaque over the left dorsal midfoot with a central 3-cm indurated pink plaque containing two shallow ulcers with yellow fibrinous bases. The patient was started on doxycycline after wound culture grew Staphylococcus aureus but was then lost to follow-up for five months. On representation, the ulcerative plaque had grown and become more cribriform in nature. Biopsy at that time revealed hyalohyphomycosis and tissue culture grew Fusarium spp. The patient was admitted to the hospital where she underwent operative debridement and was started on an extended course of voriconazole. Workup for systemic involvement was negative. She is currently being followed as an outpatient and improving.
Conclusion: We report a rare case of primary cutaneous Fusarium infection in an immunocompetent patient. Physicians should consider hyalohyphomycosis during evaluation of patients with indolent ulcers, even in the absence of immunocompromise or systemic symptoms.