Case Report: Plantar Cyst Caused by Phaeoacremonium inflatipes in an Immunocompetent Male, Resolving with Combination Potassium Iodide and Itraconazole Therapy - PubMed (original) (raw)

Case Reports

. 2022 May 31;107(1):113-116.

doi: 10.4269/ajtmh.21-0985. Print 2022 Jul 13.

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Case Reports

Case Report: Plantar Cyst Caused by Phaeoacremonium inflatipes in an Immunocompetent Male, Resolving with Combination Potassium Iodide and Itraconazole Therapy

Jaspriya Sandhu et al. Am J Trop Med Hyg. 2022.

Abstract

Phaeohyphomycosis is a subcutaneous mycosis presenting as verrucous or ulcerated plaques/nodules/cysts. We report here, a case of cystic plantar phaeohyphomycosis in a 72-year-old immunocompetent male. On examination, an asymptomatic, skin colored, firm-to-soft, fluctuant, cystic lesion was seen over the left forefoot. Aspirate of lesion yielded velvety grayish-brown colonies on fungal culture, with septate, branched, phaeoid hyphae with lateral and terminal conidiophore noted on microscopic examination, and identified as Phaeoacremonium inflatipes. Due to the ongoing pandemic and advanced age, the patient declined surgical intervention and we started him on a supersaturated solution of potassium iodide (SSKI) (starting at 5 drops thrice a day and gradually increasing 1 drop per day to 20 drops thrice a day) and itraconazole (100 mg twice daily) in combination. An encouraging response was seen at 6 weeks, with complete resolution at 6 months follow-up. We report this case for the unusual fungus isolated (i.e., P. inflatipes) as well as a robust response to a combination of SSKI and itraconazole. In cases where patients refuse or are unfit for surgical excision, this combination maybe an effective therapeutic alternative.

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Figures

Figure 1.

Figure 1.

(A) Skin colored, dome-shaped to hemispherical, firm-to-soft, fluctuant, cystic lesion was present over the left forefoot. (B) Yellow-green, thick, purulent material on aspiration with a wide-bored needle. This figure appears in color at

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Figure 2.

Figure 2.

Velvety grayish–brown colonies on fungal culture on Sabouraud’s dextrose agar. This figure appears in color at

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Figure 3.

Figure 3.

Lactophenol cotton blue preparation showing septate, branched, phaeoid hyphae with lateral and terminal conidiophore. This figure appears in color at

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Figure 4.

Figure 4.

After treatment initiation (supersaturated solution of potassium iodide + itraconazole) at: (A) 6 weeks. (B) 6 months. This figure appears in color at

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