Phaeoacremonium species detected in fine needle aspiration: a rare case report
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CASE REPORT
Open Access
Phaeoacremonium species detected in fine needle aspiration: a rare case report Santosh Tummidi1* , Bitan Naik1, Arundhathi Shankaralingappa1, Pavithra Balakrishna2, Arati Ankushrao Bhadada3 and Navya Kosaraju4
Abstract Background: Fine needle aspiration cytology (FNAC) with rapid on-site evaluation has a great potential for the diagnosis of fungal lesions and other opportunistic infections. Fungal infections have been in increasing trend in the past two decades due to immunosuppression, travel, and environmental exposure. Human disease caused by Phaeoacremonium species is rare and was first reported in 1974 as subcutaneous tissue infection in a renal transplant recipient. Case presentation: We report a case of subcutaneous tissue swelling in a 67-year-old male, wherein FNAC was done with incidental detection of the fungus (Phaeoacremonium spp). Conclusion: There are very few reported cases of subcutaneous infection in humans by Phaeoacremonium spp. Clinical suspicion and FNAC can play an important role in early detection of the fungus, prevent spread, and facilitating early treatment. Keywords: Phaeoacremonium, Fungal, Toluidine blue, Fine needle aspiration, Rapid-on-site
Background Phaeohyphomycosis is a rare form of sporadic infection that is caused by dematiaceous fungi. It’s commonly detected in tropics and sub-tropical environments. It’s a saprophyte in soil and vegetation causing Petri or esca diseases in plants [1, 2]. The first reported case was in 1974 by Ajello et al in a renal transplant patient [3]. Most often, the diagnosis is delayed due to the rarity and variable nature of the presentation [4, 5]. FNAC can play a definitive role in early identification of the disease process [6]. A high index of clinical suspicion of fungal infections (phaeohyphomycosis) should always be considered in immunocompromised patients, specifically in patients with a history of diabetics, old age, travel to tropics for early treatment [4]. We report a
* Correspondence: [email protected] 1 Department of Pathology, All India Institute of Medical Sciences, Mangalagiri, Andhra Pradesh 522503, India Full list of author information is available at the end of the article
rare case of Phaeoacremonium spp. incidentally detected in FNAC and later confirmed by fungal culture.
Case presentation A 67-year-old male daily construction labourer by profession, presented to surgical outpatient department with a subcutaneous nodule in the medial aspect of the right knee joint for 10 years. He had no significant history of any trauma. On examination the nodule was in a subcutaneous location with firm consistency, slightly tender, restricted mobility, not fixed to underlying structures and was measuring 4x3cm (Fig. 1a). Laboratory investigations revealed random blood sugar - 452 mg/dL, HbA1c value was 13% (estimated average glucose / eAG – 326 mg/dL) (Normal HbA1c < 5.7%). His hemogram, liver function and renal function tests was within normal limits. Rapid lateral flow assay tests for Human immunodeficiency vi
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