A Case of Deep Cutaneous Mycosis Caused by Purpureocillium lilacinum

Abstract

Purpureocillium lilacinum, previously known as Paecilomyces lilacinus, is a saprophytic fungus typically found in soil and decaying vegetation. Although it is infrequently pathogenic to humans, recent reports of P. lilacinum infections, primarily affecting the skin and eyes, have shown an increase. This report details a cutaneous infection caused by P. lilacinum in an 89-year-old woman. She presented with a 3-month history of an erythematous patch and nodule on her right forearm. A skin biopsy revealed inflammation, granuloma, and fungal organisms in the dermis. Periodic acid-Schiff (PAS) staining confirmed the presence of fungal elements. The fungal culture of the medium produced colonies with a velvety pink and brown hue. PCR testing on these cultured samples identified P. lilacinum. The patient received a 2-week course of oral itraconazole (200 mg/day), which improved her symptoms. However, ongoing antifungal treatment was necessary. Additionally, due to a recent myocardiac infarction, the patient required a statin. A MIC test was conducted to identify an antifungal drug compatible with statin therapy.