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Successful Terbinafine Treatment for Cutaneous Phaeohyphomycosis Caused by Trematosphaeria grisea in a Heart Transplanted Man: Case Report and Literature Review

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Abstract

Phaeohyphomycosis is a chronic infectious disease caused by dematiaceous fungi. It is characterized by the presence of pigmented septate mycelia within tissues. In the case of superficial infection, the lesion(s) chronically evolve(s) toward painless pseudo-tumor(s) of the soft parts. We report herein the original case of a heart transplanted man who exhibited phaeohyphomycosis of the left hand, with no mention of travels in endemic areas. Trematosphaeria grisea was identified as the causative agent, which is quite innovative since this species has been rather described in mycetoma. The antifungal treatment initially based on isavuconazole alone was not sufficient to cure the patient. In contrast, its association with local terbinafine ointment allowed total clinical improvement. This finding is unusual as diagnosis of phaeohyphomycosis caused by T. grisea is uncommon in nontropical countries, and as the outcome appeared successful by the means of add-on therapeutic strategy with terbinafine.

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Acknowledgements

The authors are thankful to the patient. He did not oppose the publication of his medical case.

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Authors and Affiliations

  1. Parasitologie – Mycologie et Médecine Tropicale, Hôpital Bretonneau, CHU de Tours, 2 Boulevard Tonnellé, 37044, Tours, France

    Victor Mercier, Éric Bailly & Guillaume Desoubeaux

  2. Médecine Interne Et Maladies Infectieuses, CHU de Tours, Tours, France

    Frédéric Bastides & Louis Bernard

  3. CNRS, National Reference Center for Invasive Mycoses and Antifungals (NRCMA), Molecular Mycology Unit, UMR2000, Institut Pasteur, Paris, France

    Dea Garcia-Hermoso

  4. Anatomie Et Cytologie Pathologiques, CHU de Tours, Chambray-les-Tours, France

    Elodie Miquelestorena-Standley & Anne De Muret

  5. Radiologie, CHU de Tours, Chambray-les-Tours, France

    Zaki El Baz

  6. Chirurgie orthopédique Et Traumatologie, CHU de Tours, Chambray-les-Tours, France

    Emilie Marteau

  7. Chirurgie Cardiaque, CHU de Tours, Tours, France

    Emmanuelle Vermes

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  1. Victor Mercier
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Mercier, V., Bastides, F., Bailly, É. et al. Successful Terbinafine Treatment for Cutaneous Phaeohyphomycosis Caused by Trematosphaeria grisea in a Heart Transplanted Man: Case Report and Literature Review. Mycopathologia 185, 709–716 (2020). https://doi.org/10.1007/s11046-020-00467-4

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