SCEDOSPORIUM CUTANEOUS INFECTION REVEALED BY BULLOUS AND NECROTIC PURPURA

Background. Non-mycetomatous cutaneous scedosprium is an uncommon myco sis observed in immunodepressed subjects. We report a case with an ina ugural presentation of bullous and necrotic purpura. Case report. A 79 -year-old man on intermittent corticosteroid therapy for bronchospasm was admitted for bullous and necrotic purpura and fever. Subcutaneous nodules with a sporotrichoid aspect developed despite wide-spectrum an tibiotics. Microbiology samples cultured on Sabouraud medium evidenced Scedosporium apiospermum. The pathogenic nature of the infection was proven on a skin biopsy showing numerous myceleal filaments with Gomor i-Grocott staining despite negative PAS. No pulmonary involvement was evidenced. The patient was treated unsuccessfully with itraconazole. A Pseudomonas lung infection was fatal. Discussion. Scedosporium apiosp ermum, an ubiquitous ascomycetes anamorphous to Pseudallescheria boydi i, is the cause of a growing number of human infections due to widespr ead use of immunosuppressors. Skin and lung localizations predominate. The inaugural bullous and necrotic purpural skin manifestations in th is case are unusual. In addition, the patient was only minimally immun odepressed and despite demonstrated in vitro sensitivity, itraconazole was ineffective clinically. Treatment is not well defined, but surger y is essential in combination with empirically chosen antifungals.