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Simultaneous infection with Fusarium proliferatum and Prototheca wickerhamii localized at different body sites

Summary

An 81-year-old woman taking long-term steroid medication developed two different fungal skin infections on her hands simultaneously – one on the right hand from a moldy wooden frame and one on the left hand possibly from sewage exposure. Doctors identified both fungi through microscopy and genetic testing. She was successfully treated with an antifungal medication called voriconazole for four weeks and recovered completely.

Background

Subcutaneous infections caused by two unusual fungi are rare. Fusarium proliferatum is a ubiquitous soil inhabitant that seldom infects humans, while Prototheca wickerhamii is the most common Prototheca species responsible for human infections. Both are susceptible to infections in immunocompromised populations.

Objective

To report and document the first known case of simultaneous co-infection with both Fusarium proliferatum and Prototheca wickerhamii in an 81-year-old immunocompromised woman with long-term glucocorticoid use.

Results

Histopathological examination revealed fungal hyphae on the right hand and characteristic wheel-like sporangia on the left hand. Fungal cultures and molecular sequencing identified Fusarium proliferatum on the right dorsum and Prototheca wickerhamii on the left dorsum. Antifungal susceptibility testing showed both organisms were sensitive to voriconazole, amphotericin B, and posaconazole.

Conclusion

The patient was successfully treated with oral voriconazole 400 mg/day for four weeks, achieving clinical cure with no recurrence over 5-month follow-up. This case represents the first documented co-infection with both fungi and demonstrates successful treatment outcomes in immunocompromised hosts.
  • Published in:Medical Mycology Case Reports,
  • Study Type:Case Report,
  • Source: PMID: 37808220, DOI: 10.1016/j.mmcr.2023.100610
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