A case of subcutaneous phaeohyphomycosis caused by Exophiala oligosperma showing multiple cysts

Exophiala species are dark pigmented fungi associated with phaeohyphomycosis that exhibit yeast-like or hyphal forms of the fungus in superficial subcutaneous locations or systemic disease. The incidence of subcutaneous tissue infection of Exophiala species has recently increased, particularly in immunocompromised hosts. In Korea, E. jeanselmei, E. dermatitidis, and E. salmonis were isolated from patients with phaeohyphomycosis. However, there have been no case reports of phaeohyphomycosis caused by E. oligosperma. Here we report the first case of phaeohyphomycosis caused by E. oligosperma in Korea. An 82-year-old female with competent immune function presented with multiple subcutaneous masses on the dorsum of the left hand and wrist. A histopathological examination of the skin specimen revealed granulomatous inflammation with fungal hyphae and yeast. Molecular identification was performed using internal transcribed spacer sequences analysis. The sequence showed 100% identity with the E. oligosperma strains. She was treated with oral itraconazole and showed improvement.