Hand surgeon diagnosis and management of cutaneous infection with Purpureocillium lilacinium of the upper extremity: A mimicker of necrotizing fasciitis

Matthew B. Weber, Brady Ernst, Omar Protzuk, J. Frankenhoff
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Abstract

Purpureocillium lilacinum is a filamentous fungus commonly found in soil that has been recognized as an opportunistic pathogen. Cutaneous infections with Purpureocillium lilacinum are relatively rare, and they usually occur in individuals with some predisposing factors such as minor trauma or pre-existing skin conditions. Infections in immunocompetent individuals are unexpected due to the fungus’s typically low pathogenicity and the robust immune response of healthy individuals. In immunocompetent hosts, the skin serves as an effective barrier against many fungal infections. While cases of cutaneous infections in immunocompetent hosts have been documented, they are considered rare outliers. Presented is the case of a 93-year-old male who presented to the emergency department with a 10-day history of progressive, painful left upper extremity erythema and swelling. The patient had aggressive progression of hemorrhagic bullae requiring surgical debridement. While the patient’s presentation was originally thought to be consistent with necrotizing fasciitis, only cutaneous necrosis was encountered, and the patient was ultimately diagnosed with a superficial P. lilacinum infection. The failure of treatment leading to death in the described case could be attributed to a combination of factors including intrinsic resistance of the fungus, delayed diagnosis, underlying health conditions, antifungal susceptibility variations, fungal persistence, and immunosuppressive factors.
手外科医生对上肢紫癜癣菌皮肤感染的诊断和处理:坏死性筋膜炎的模仿者
紫云英真菌是一种常见于土壤中的丝状真菌,被认为是一种机会性病原体。紫云英真菌的皮肤感染相对罕见,通常发生在有轻微外伤或原有皮肤病等易感因素的人身上。由于这种真菌的致病性通常很低,而且健康人的免疫反应很强,因此在免疫功能正常的人身上发生感染是意料之外的。在免疫功能健全的宿主中,皮肤是抵御许多真菌感染的有效屏障。虽然免疫功能正常的宿主也有皮肤感染的病例,但这些病例被认为是罕见的异常情况。本病例是一名 93 岁的男性患者,因左上肢进行性疼痛性红斑和肿胀就诊于急诊科,病史长达 10 天。患者的出血性鼓包呈侵袭性进展,需要进行手术清创。虽然患者的表现最初被认为符合坏死性筋膜炎的特征,但后来只出现了皮肤坏死,患者最终被诊断为浅表紫丁香杆菌感染。该病例治疗失败导致死亡的原因可能是多种因素共同作用的结果,包括真菌的内在抗药性、诊断延误、潜在的健康状况、抗真菌药敏性变化、真菌持续存在以及免疫抑制因素。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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