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Report of a Case and Review of the Cutaneous and Histologic Manifestations

George T. Nahass, MD; Steven P. Rosenberg, MD; Craig L. Leonardi, MD; Neal S. Penneys, MD, PhD

Arch Dermatol. 1993;129(8):1020-1023.

Abstract
Background
Trichosporonosis is a potentially life-threatening disseminated infection with Trichosporon beigelii, the causative agent of white piedra. Systemic infection by this fungus has been most frequently described in immunocompromised hosts with neutropenia, but one case has been reported in the acquired immunodeficiency syndrome setting. We report a second case of trichosporonosis in a patient with acquired immunodeficiency syndrome and review the clinical and histologic characteristics of cutaneous involvement with this opportunistic fungal pathogen.

Observations
Trichosporonosis occurs most commonly in neutropenic patients receiving chemotherapy. We describe the second case developing in the acquired immunodeficiency syndrome setting. Cutaneous involvement occurred in approximately 30% of patients and most frequently presented as purpuric papules and nodules with central necrosis or ulceration. Biopsy specimens of these lesions revealed dermal invasion by fungal elements, and culture was positive in greater than 90% of the cases.

Conclusions
Disseminated infection with T beigelii can occur in immunosuppressed patients, including those with acquired immunodeficiency syndrome particularly if associated with neutropenia. Cutaneous involvement is common, presenting as purpuric papules and nodules. Biopsy and culture of cutaneous findings can help establish an accurate diagnosis resulting in rapid and appropriate treatment.

(Arch Dermatol. 1993;129:1020-1023)

Author Affiliations
From the Department of Internal Medicine, Division of Dermatology, St Louis (Mo) University Medical Center (Drs Nahass, Leonardi, and Penneys); and Department of Dermatology and Cutaneous Surgery, University of Miami (Fla) (Dr Rosenberg).

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