INVASIVE NATTRASSIN-MANGIFERAE INFECTIONS - CASE-REPORT, LITERATURE-REVIEW, AND THERAPEUTIC AND TAXONOMIC APPRAISAL

We report on a case of subcutaneous infection of the arm caused by the coelomycetous fungus Nattrassia mangiferae (formerly Hendersonula tor uloidea) in a steroid-dependent diabetic man with chronic obstructive lung disease. The man was a resident of Arizona, where the fungus is k nown to be endemic on Eucalyptus camaldulensis and on citrus trees. Di agnosis of fungal infection was made by observation of narrow hyphal f ilaments by histopathology of biopsy specimens and isolation of a fast -growing black mold which demonstrated hyphae and arthroconidia of var ying widths typical of the Scytalidium synanamorph (S. dimidiatum). Th e formation of pycnidia, which at maturity expressed conidia with a ce ntral median dark band, allowed for the confirmation of the isolate as N. mangiferae. Remission of the lesions occurred following intravenou s therapy with amphotericin B, followed by topical clotrimazole treatm ent, We use this patient's case report as an opportunity to review the literature on cases of deep infection caused by Scytalidium species, to evaluate the antifungal susceptibilities of a spectrum of Scytalidi um isolates, and to review the taxonomy of Scytalidium species isolate d from human infections.