Clinical analysis of cutaneous phaeohyphomycosis caused by Veronaea botryosa

Objective Phaeohyphomycosis is a fungal dermatopathy caused by a variety of dematiaceous fungi,and Veronaea botryosa is a rare agent of human phaeohyphomycosis.This article reports a case of cutaneous phaeohyphomycosis caused by Veronaea botryosa.Methods The patient was a 16-year-old girl,presented with crusted verrucous lesions initially on the left ear and later on the left buttock within 2-5 months after receiving an ear piercing.Smear,fungal culture and histopathologic examination were carried out on the specimens collected from the patient's lesions,and rDNA ITS sequence analysis was performed for the identification of the isolated strains.Results Microscopy demonstrated numerous septate,branched and yellowish-to-brownish hyphae with lateral and terminal conidiophores.The conidiophores were erect,straight or flexous,occasionally branched,rarely geniculate,smooth walled,septate,and pale brown.Lots of velvety,olivaceous gray colonies grew on the PDA culture medium.Microscopic examination of the HE-stained tissue slides revealed a chronic granulomatous inflammation.Septate,branched or unbranched pale brown hyphae of various lengths were observed in the tissue examined.PAS and Gomori methenamine silver stains also showed positive septate hyphae.The strain was identified as Veronaea botryosa by ITS sequence analysis.Itraconozole combined with thermotherapy produced satisfactory results.Conclusion The pathogen of this case of cutaneous phaeohyphomycosis was Veronaea botryose,which responded well to traconozole plus thermotherapy.