case_images: PMC11165563_01
case_images: A) Tumor with lobulated surface and fistulous ostia, with drainage of serosanguineous material, without grains, located on the dorsum of the left foot; B) Magnetic resonance imaging depicting multiple septa and nodules affecting deep tissue planes, containing exudate, without bone involvement.
case_images: 1678-9946-rimtsp-66-S1678-9946202466034-gf01.jpg
case_images: PMC11165563_01_1678-9946-rimtsp-66-S1678-9946202466034-gf01.jpg
case_images: f1
case_images: On examination, a skin lobulated tumor was noted on the dorsum of the left foot, with the presence of fistulous ostia and drainage of serosanguineous material (Figure 1A). A magnetic resonance imaging (MRI) examination of the affected foot was performed for better therapeutic planning (Figure 1B).
case_images: A) Direct examination of skin scrapings in Potassium Hydroxide (KOH) 20%, showing filamentous hyphae; B) Characteristic structures of the Colletotrichum gloeosporioides complex at 40x magnification.; C) Chronic granulomatous suppurative dermatitis presenting frequent filamentous fungal structures, without grains, observed in Hematoxylin-eosin staining at 400x magnification; D) Grocott's methenamine silver staining of sinus mucosal biopsy demonstrating diverse fungal elements, including broad, pauci-septate hyphae (5-10 microm), suggestive of mucormycosis, and thinner hyphae, mostly with right-angle branching, indicative of hyalohyphomycosis
case_images: 1678-9946-rimtsp-66-S1678-9946202466034-gf02.jpg
case_images: PMC11165563_01_1678-9946-rimtsp-66-S1678-9946202466034-gf02.jpg
case_images: f2
case_images: A chronic granulomatous suppurative dermatitis with frequent filamentous fungal structures was observed on the histological sections (Figures 2C and 2D). Samples were cultured on potato dextrose agar (PDA) and subjected to mass spectrometry technique, finding positive results for Colletotrichum gloeosporioides species complex (Figures 2A and 2B)   .
case_images: A) Nodular lesion measuring 1.5 cm in diameter, located on the right upper forearm; B) Colonies of Exophiala oligosperma complex cultured on Saboraud Dextrose Agar after 2 months of growth; C) Muriform cells observed in Periodic acid-Schiff (PAS) staining at 400x magnification; D) Muriform cells observed in hematoxylin-eosin staining at 400x magnification.
case_images: 1678-9946-rimtsp-66-S1678-9946202466034-gf03.jpg
case_images: PMC11165563_01_1678-9946-rimtsp-66-S1678-9946202466034-gf03.jpg
case_images: f3
case_images: Despite using itraconazole 200 mg/day, the patient developed, in 2021, a nodular lesion, nonadherent, on the right upper forearm, which evolved after one year, growing to 1.5 cm in diameter (Figure 3A). Direct microscopy research of this new lesion showed dematiaceous fungi isolated from microculture (Figure 3B) and fungal structures suggestive of muriform cells in a skin fragment histology (Figures 3C and 3D).