Hyalohyphomycete or zygomycete? Challenges with microscopic diagnosis

نویسندگان

چکیده

Background: Invasive mould infections are associated with profound morbidity. Direct microscopic examination of specimens is a useful tool for laboratories to advise clinicians on the presumptive identity. Nonetheless, pitfalls abound. Here, we highlight how microscopy may not always be straightforward. Case description: A 69-year-old male T cell lymphoma was admitted chemotherapy. Shortly after conditioning, he developed hand cellulitis which progressed 10 cm necrotic ulcer despite vancomycin and piperacillin-tazobactam. Skin biopsy performed. Gram stain calcofluor white revealed narrow hyphae suggestion septa 45 degree branching. Given clinical syndrome (eschar in an immunocompromised host), communicated our suspicion Fusarium clinician, who started voriconazole. Overnight, cottony grew. Lactophenol cotton blue irregular, broad, ribbon-like sporangia. The clinician informed possibility Mucorales. Antifungals were switched liposomal amphotericin B. Internal transcribed spacer sequencing subsequently confirmed as Rhizopus arrhizus. Antifungal susceptibility testing MICs 1 μg/ml >8 B voriconazole respectively. Discussion: findings should correlated colonial morphology. Clinicians promptly critical so appropriate treatment can instituted.

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ژورنال

عنوان ژورنال: Pathology

سال: 2023

ISSN: ['1465-3931', '0031-3025']

DOI: https://doi.org/10.1016/j.pathol.2022.12.144