PHAEOHYPHOMYCOSIS OF THE EPIDIDYMIS CAUSED BY EXOPHIALA JEANSELMEI

Abstract

The dematiaceous (dark walled) fungi are a heterogenous group of organisms that includes members of the genus Exophiala.l-* Exophiala species are ubiquitous in nature and are the most common etiological agents in phaeohyphomycosis (granulomatous infection due to dematiaceous fungiha Phaeohyphomycosis usually involves superficial and cutaneous sites but can also cause subcutaneous and systemic disease.1-3.5 Although dematiaceous fungi can infect extra cutaneous locations, to our knowledge they have not been described as a pathogen in the genitourinary ~ystem.l-~,~ We report a case of phaeohyphomycosis of the epididymis caused by Exophiala jeanselmei variant lecanii-corni following hydrocele needle aspiration which was successfully treated with epididymo-orchiectomy. CASE REPORT A 54-year-old man from Pennsylvania was referred to our institution for treatment of a right testicular abscess diagnosed on 'indium-labeled white blood cell radionuclide imaging. There was no history of immunosuppression (human immunodeficiency virus infection or steroid therapy), malignancy, diabetes mellitus, urinary tract infection or manipulation, nor were there any notable environmental or occupational exposures (farming, gardening or carpentry) to fungi. The patient had a 12-month history of a recurrent right hydrocele treated with repetitive percutaneous needle aspirations and, subsequently, epididymo-orchitis developed which was refractory to various broad-spectrum antibiotics. At presentation the patient was afebrile with no evidence of systemic disease. The genitourinary examination was unremarkable except for a fluid-filled sac surrounding a tender right testis and epididymis. Laboratory data included a normal white blood cell count and negative urine culture. Scrota1 exploration revealed a firm nodule in the epididymis surrounded by a loculated hydrocele. The right scrotal