case_images: PMC11390559_01
case_images: (A) Severe swelling, multiple ulcers and purulent secretions of the left lower limb, with scattered darkening indurations were observed and skin temperature of the indurated area was elevated; (B) Magnetic resonance imaging showed abnormal signals in various muscle groups and subcutaneous soft tissues of the left leg, indicating inflammatory lesions and abscesses. Increased signals were observed in the ligaments and tendons of the left foot, indicating inflammatory lesions and surrounding soft tissue swelling; (C) Subcutaneous abscesses debridement and drainage; (D) A significant amount of yellow purulent secretion was drained; (E, F) Gram staining and calcofluor white fluorescent staining revealed broad, irregularly branched, ribbon-like hyphae, x1000; (G) Flat greyish-white colony on blood agar with filiform margins incubated at 35 C for 72 hours; (H) White to yellow-white, radiating colonies on PDA with few aerial hyphae incubated at 35 C for 72 hours; (I) After 24 days of treatment, most skin ulcers have successfully healed.
case_images: fcimb-14-1430032-g001.jpg
case_images: PMC11390559_01_fcimb-14-1430032-g001.jpg
case_images: f1
case_images: Scattered darkening indurations were observed and skin temperature of the indurated area was elevated ( Figure 1A ). Increased signals were observed in the ligaments and tendons of the left foot, indicating inflammatory lesions and surrounding soft tissue swelling ( Figure 1B ). Local debridement and abscess incision drainage were performed after admission ( Figure 1C ), and a significant amount of yellow purulent secretion was drained and sent for culture ( Figure 1D ). On the second day of admission, Gram staining and calcofluor white-fluorescent staining of the wound secretion revealed broad, irregularly branched, ribbon-like hyphae, highly suggestive of fungal infection ( Figures 1E, F ). Flat greyish-white colony on blood agar with filiform margins and white to yellow-white, radiating colonies with few aerial hyphae on potato dextrose agar (PDA) were observed after 72 hours culture at 35 C ( Figures 1G, H ). After 24 days of treatment, most skin ulcers have successfully healed ( Figure 1I ).
case_images: PMC11390559_02
case_images: (A1, A2) The left eye showed dense central stromal opacity surrounded by a reticular pattern of subepithelial and superficial stromal infiltration; (B) Confocal microscopy displayed a large amount of filamentous structures at the lesion of the left cornea; (C, D) Corneal scraping with Gram staining and calcofluor white fluorescent staining revealed broad, irregularly branched, ribbon-like hyphae, x1000; (E) Corneal scraping culture showed flat greyish-white colony on blood agar with filiform margins incubated at 35 C for 48 hours.
case_images: fcimb-14-1430032-g002.jpg
case_images: PMC11390559_02_fcimb-14-1430032-g002.jpg
case_images: f2
case_images: The left eye showed dense central stromal opacity surrounded by a reticular pattern of subepithelial and superficial stromal infiltration ( Figures 2A1, A2 ). Confocal microscopy displayed a large amount of filamentous structures at the lesion of the left cornea ( Figure 2B ). Corneal scraping with Gram staining and calcofluor white-fluorescent staining revealed broad, irregularly branched, ribbon-like hyphae ( Figures 2C, D ). Corneal scraping culture showed flat greyish-white colony on blood agar with filiform margins incubated at 35 C for 48 hours ( Figure 2E ).