C-192. Exserohilum sp. Infections in Immunocompromised Pediatric Patients

S. D. Dallas1, D. G. Rupar2, H. W. Clegg3, R. L. Sautter4;
1Carilion Labs, Charlotte, NC, 2Levine Children's Hosp. at Carolinas Med. Center, Charlotte, NC, 3Levine Children's Hosp., Hemby Children's and Presbyterian Hosp., Charlotte, NC, 4Carolinas Pathology Group, Carolinas Lab. Network, Charlotte, NC.

Background:. Exserohilum sp. are dematiaceous fungi found naturally in soil and vegetation and are a known cause of phaeohyphomycoses. There are over 20 species in the genus, of which E. rostratum and E. longirostratum are the most frequent species infecting humans. Many antifungal drugs are active against Exserohilum, though increased MIC values may be seen with fluconazole. Morphologically, the fungus is most commonly confused with Bipolaris, Curvularia, Drechslera, and Helminthosporium. We report two cases of Exserohilum infections in children with leukemia. Case Reports: Case one was a 3 yr old WF admitted with new-onset acute lymphocytic leukemia (ALL). She was started on chemotherapy. One week later, a single small red, papular lesion was noted on her right anterior knee and was thought possibly to be a fungal infection. The patient was started on oral voriconazole. Seven days later, the right knee lesion was larger, about 1 cm in size, and had a necrotic center. Three additional lesions, approximately 5 mm in size, were noted on the right forearm, right lower thigh, and left lower leg. Cultures from biopsy of the lesion revealed E. longistratum. She is currently being treated with antifungal therapy and has improved. Case two was a 9 yo old WF being treated for ALL. One week prior to being seen the patient was bitten on her thumb by her family dog. Two days later the thumb became erythematous and swollen, and later developed a necrotic center. The patient spiked a fever of 101 F and was found to be neutropenic. A biopsy taken from the thumb revealed septate hyphae, and culture grew E. rostratum. No dissemination of disease was found, and she recovered with twelve weeks of antifungal therapy. Conclusions: Fungi from the genus Exserohilum can cause infections in immunocompromised hosts. Identification is based on morphology and requires expertise in differentiating closely related species. Optimal treatment is unknown, but clinical outcome can be good with debridement and antifungal therapy. These cases demonstrate the pathogenic potential of these organisms, and the value of biopsy in the management of unknown skin lesions in immunocompromised children.