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( Mariko Mochizuki ),( Yukari Osada ),( Nami Shimaoka ),( Mayumi Ito ),( Naomi Sannda ),( Junko Fujita ),( Hiroyuki Matumoto ),( Tadashi Matushita ) 대한임상병리사협회 2015 임상미생물검사학회 발표자료집 Vol.2015 No.-
Case The patient was a 45-year-old man. He was diagnosed as having malignant melanoma ten years ago, and received chemotherapy including alkylating agents. After nine years, he developed treatment-related myelodysplastic syndrome / myeloproliferative neoplasm (MDS / MPN), and he received hematopoietic stem cell transplantation. He had recurrence as MDS and re-transplanted. The blood culture after re-transplantation were repeatedly positive for Enterococci and yeast-like fungi of black-colored colony. Micafungin (MCFG) and Fluconazole were added to the treatment with liposomal-amphoterisin B. Hematopoetic stem cell transplantation was performed again due to bone marrow graft failure, however, his condition got worsened and died. Microbiological findings A yeast-like form with budding was found under microscopy, and black-colored colonies were grown on a CHROMagarTM Candida plate (Becton Dickinson). Species identification was not possible using VITEK and ApiC AUX (bioMerieux). Further culture revealed brown filamentous form on the melted chocolate-like colonies, which was strongly suggestive of dimorphic fungi. This fungus was identified as Exophiala dermatitidis by sequence analysis of ITS region of rRNA gene. Susceptibility test using the ASTY (KYOKUTO PHARMACEUTICAL INDUSTRIAL Co., Ltd) showed that, after 72hr growth, a high MIC values of > =16㎍/ml in MCFG and relatively good susceptibility to other antifungal drugs. Discussion Exophiala dermatitidis is a type of pathogenic dematiaceous fungi which was widely found in residential environment. It mainly causes infections of cutaneous and subcutaneous tissue in immunocompromised patients, but sometimes fatal infections such as bloodstream infection. In clinical settings, it is important to speculate this species from morphological features, which will lead to the early diagnosis and treatment especially in immunocompromised cases. Acknowledge Takashi Yaguchi, Aki Hirabayashi, Daizo Kato, Mitsutaka Iguchi, Satoshi Morioka, Tetsuya Yagi
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