Cutaneous P. lilacinum Hyalohyphomycosis Infection: Atypical Histomorphology in an Immunocompetent Patient.
Alexandra Hill-Ricciuti, Roman Drozdowski, Brett Sloan et al.
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Case in brief
A 73-year-old immunocompetent man presented with pruritic, pink-to-violaceous plaques and papules on his right forearm, persisting for 2-3 years. Biopsy revealed superficial granulomatous dermatitis without visible fungal forms, but special stains identified non-pigmented fungal elements. Culture confirmed the presence of Purpureocillium lilacinum. The patient was treated with oral terbinafine, leading to resolution of lesions by 12 weeks.
What made this case unusual
The case highlights an atypical presentation of cutaneous hyalohyphomycosis in an immunocompetent patient, which is uncommon as such infections are typically associated with immunocompromised individuals.
Diagnostic / clinical pearl
Clinicians should consider hyalohyphomycosis in patients with chronic cutaneous lesions, even in immunocompetent individuals, and utilize special stains and cultures for accurate diagnosis.
Why it matters
This case underscores the importance of recognizing atypical fungal infections and the role of histopathology and microbiologic culture in diagnosing cutaneous fungal diseases.