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

Victor Mercier (1, 2) , Frédéric Bastides (2) , Eric Bailly (1, 2) , Déa Garcia-Hermoso (3, 4, 5) , Elodie Miquelestorena-Standley (2) , Zaki El Baz (2) , Emilie Marteau (2) , Emmanuelle Vermes (2) , Anne de Muret (2) , Louis Bernard (2) , Guillaume Desoubeaux (1, 2, 6)

1 Hôpital Bretonneau
2 CHRU Tours - Centre Hospitalier Régional Universitaire de Tours
3 IP - Institut Pasteur [Paris]
4 CNRMA - Centre National de Référence Mycologie et Antifongiques-Mycologie Moléculaire
5 Mycologie moléculaire - Molecular Mycology
6 CEPR - Centre d’Etude des Pathologies Respiratoires (CEPR), UMR 1100

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.

Mots clés: Phaeohyphomycosis; Dematiaceous fungus; Trematosphaeria grisea; Isavuconazole; Terbinafine

Domaines: Mycologie

Victor Mercier, Frédéric Bastides, Eric Bailly, Déa Garcia-Hermoso, Elodie Miquelestorena-Standley, et al.. Successful Terbinafine Treatment for Cutaneous Phaeohyphomycosis Caused by Trematosphaeria grisea in a Heart Transplanted Man: Case Report and Literature Review. Mycopathologia, 2020, 185 (4), pp.709-716. ⟨10.1007/s11046-020-00467-4(⟩. ⟨pasteur-03224035⟩