SYSTEMIC PHEOHYPHOMYCOSIS CAUSED BY EXOPHIALA-DERMATITIDIS

We report a case of systemic phaeohyphomycosis due to Exophiala dermat itidis in a 24-year-old man. At the age of 17, the patient had noticed cervical swellings. On palpation at his initial examination, more tha n a dozen firm lymph nodes between 1 and 5 cm in diameter were found o n both sides of the neck and in both axillae. Examination of biopsy sp ecimens of lymph nodes revealed pale brown hyphae in granulomatous les ions and Exophiala dermatitidis was isolated from mycological cultures of the local tissues. The clinical course was marked by an episode of jaundice six months later, and surgery disclosed a fist-sized inflamm atory mass in the region of the head of the pancreas and the duodenum. The patient was treated by providing external biliary drainage and by the administration of antifungal agents, but two years later complain ed of diplopia and a slight heaviness in the head. Computed tomographi c scans were made of the head, revealing multiple plum-sized masses in the brain. The patient died a year later. In Japan, 10 cases of syste mic infection by this organism (including the present one) have been r eported, all in patients of up to 30 years of age, with lesions appear ing in the brain, lung, liver, digestive organs and lymph nodes. The p rognosis is grave.