Madurella infection in an immunocompromised host

A 77-year-old farmer, born and living in Sardinia, affected by acute myelogenous leukemia and undergoing chemotherapy treatment with cytosine arabinoside, presented at the Institute of Dermatology of Sassari in March 1998 with multiple subcutaneous lesions on the legs (Fig. 1) which had appeared 3 months previously. Scattered crusts were observed, and some nodules were necrotizing and ulcerated with a discharge of serosanguineous fluid. There was nodules were necrotizing and ulcerated with a discharge of serosanguineous fluid. There no history of trauma. A deep biopsy was performed and histologic examination showed suppurative inflammation in the middle and deep dermis with a mass of hyphae and numerous spores at periodic acid-Schiff (PAS) reaction (Fig. 2). Culture of a small skin sample at 37 degreesC on Saboraud's dextrose agar resulted, 7 days later. in the development of flat, brownish, fluffy colonies. The reverse of the colony was black. Microscopically, the culture showed broad, segmented hyphae without conidia and with chlamydospores typical of Madurella. X-Ray findings of the lower extremities showed no bony involvement. Oral itraconazole at a dosage of 100 mg twice daily was started and clinical evaluation demonstrated lesion resolution after 12 weeks with no adverse reaction. The patient had no evidence of relapse at follow-up 10 months later.