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Abstract

Background: Superficial dermatomycosis, predominantly caused by dermatophytes, affects approximately 20–25% of the global population. However, non-dermatophytic fungi, such as Cladophialophora species (sp.), can also cause similar cutaneous infections. Although less common, these organisms are particularly concerning in immunocompromised individuals.

Case Illustration: A 66-year-old immunocompromised male presented with widespread pruritic and erythematous patches, initially misdiagnosed as tinea corporis. Despite receiving standard antifungal therapy, his condition persisted. Further investigation through fungal culture identified Cladophialophora sp., which was resistant to common antifungal agents such as fluconazole, itraconazole, and ketoconazole. However, the fungus was sensitive to terbinafine, which has been successfully used to treat extensive superficial dermatomycosis.

Discussion: This case highlights the ability of non-dermatophytic fungi, especially Cladophialophora sp., to cause extensive superficial dermatomycosis, especially in immunocompromised patients. The patient’s compromised immune system likely contributed to the extensive nature of the lesions. In this case, antifungal resistance may have been exacerbated by prior unsupervised self-medication and environmental exposure.

Conclusion: We report an immunocompromised patient with inadequate prior antifungal treatment who developed extensive superficial dermatomycosis caused by Cladophialophora sp., a deep mycosis pathogen resistant to multiple azoles, highlighting the role of host immunity and inappropriate unsupervised therapy in disease severity and antifungal resistance.

References

  1. Pathave H, Dash M, Sarangi G, Mohanty P, Bisoyi D. Clinicomycological study of superficial mycoses: A changing trend of increasing non-dermatophyte mold infection. J Coll Med Sci-Nepal. 2022;18(1):49–59.
  2. Leung AK, Lam JM, Leong KF, Hon KL. Tinea corporis: An updated review. Drugs Context. 2020;9:1–12.
  3. Das K, Lee SY, Jung HY. Cladophialophora lanosa sp. nov., a new species isolated from soil. Mycobiology. 2019;47(2):173–9.
  4. Grover S, Roy P. Clinico-mycological profile of superficial mycosis in a hospital in North-East India. Med J Armed Forces India. 2003;59(2):114–6.
  5. Shree A, Pal S, Verma PK. Structural diversification of fungal cell wall in response to the stress signaling and remodeling during fungal pathogenesis. Physiol Mol Biol Plants. 2024;30(5):733–47.
  6. Richardson M, Edward M. Model systems for the study of dermatophyte and non-dermatophyte invasion of human keratin. In: Kushwaha RKS, Guarro J, editors. Biology of dermatophytes and other keratinophilic fungi [Internet]. Bilbao: Revista Iberoamericana de Micología; 2000 [cited 2024 Jun 15]. p. 115–21. Available from: https://www.dermatophytes.reviberoammicol.com
  7. Sharma B, Nonzom S. Superficial mycoses, a matter of concern: Global and Indian scenario-an updated analysis. Mycoses. 2021;64(8):890–908.
  8. Thitla T, Kumla J, Khuna S, et al. Research advances in taxonomy, phylogeny, ecology, and distribution of the genus Cladophialophora. Chiang Mai Journal of Science. 2024;51(1):1–23.
  9. Frederiks AJ, Delaney T. A rare Australian case of cutaneous Cladophialophora bantiana and review of the literature. Acta Derm Venereol. 2021;101(7):1–2.
  10. Brasch J, Dressel S, Müller-Wening K, Hügel R, von Bremen D, de Hoog GS. Toenail infection by Cladophialophora boppii. Med Mycol. 2011;49(2):190–3.
  11. Jang MS, Park JB, Yang MH, et al. Superficial mycosis of the foot caused by Cladophialophora boppii. J Dermatol. 2018; 45(6):e144–5.
  12. Jartarkar SR, Patil A, Goldust Y, et al. Pathogenesis, immunology and management of dermatophytosis. J Fungi (Basel). 2021;8(1):1–15.
  13. Sahoo AK, Mahajan R. Management of tinea corporis, tinea cruris, and tinea pedis: A comprehensive review. Indian Dermatol Online J. 2016;7(2):77–86.
  14. Ray A, Das A, Panda S. Antifungal stewardship: What we need to know. Indian J Dermatol Venereol Leprol. 2023;89(1):5–11.
  15. Monod M, Feuermann M, Yamada T. Terbinafine and itraconazole resistance in dermatophytes. In: Bouchara JP, Nenoff P, Gupta AK, Chaturvedi V, editors. Dermatophytes and dermatophytoses [Internet]. Cham: Springer; 2021. p. 415–29. [cited 2024 Jun 20]. Available from: https://doi.org/10.1007/978-3-030-67421-2_20
  16. Badali H, Gueidan C, Najafzadeh MJ, Bonifaz A, van den Ende AH, de Hoog GS. Biodiversity of the genus Cladophialophora. Stud Mycol. 2008;61:175–91.

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