Selülit Benzeri Cilt Bulgularıyla Ortaya Çıkan Kutanöz Scedosporium apiospermum Olgusu ve Literatür İncelemesi

In this report a case of cutaneous Scedosporium apiospermum infection in 75-year-old woman with asthma who was receiving long-term therapy with corticosteroids was presented. She was hospitalized in the department of chest diseases for the follow-up of worsening dyspnea, cor pulmonale and stasis dermatitis. Erythema, localized tenderness and swelling developed on her left foot dorsum during her follow-up in the hospital. A few days later, black-colored papules with an erythematous base were observed on her foot dorsum and anterior surface of the tibia. She was diagnosed with cellulitis. Skin biopsy revealed numerous septated fungal hyphae. Preemptive amphotericin B was added to the antibacterial treatment. Within 48 h of incubation, the Scedosporium colony was isolated based on conventional methods. The fungal ribosomal RNA gene internal transcribed spacer sequence analysis revealed S.apiospermum and deposited into GenBank with accession number OM948685. The minimum inhibition concentration was defined as 1 µg/mL for amphotericin B; 16 µg/mL for fluconazole; 0.25 µg/mL voriconazole, 4 µg/mL for caspofungin, 1 µg/mL for itraconazole and 0.125 µg/mL for posaconazole on 48 h of incubation. The patient was transferred to the intensive care unit due to the deterioration of her general condition with the diagnosis of sepsis. Antimicrobial treatment was modified to caspofungin/ voriconazole combination and imipenem administration. Hepatic failure, bone marrow suppression with severe thrombocytopenia and disseminated intravascular coagulation syndrome developed on the third day of intensive care unit stay. The patient died of severe septic shock and multiorgan failure. We also reviewed the literature presenting similar cutaneous scedosporiosis cases and discussed the results.