Scedosporium spp.

This is a 50ish yo man with chronic use of steroids who present with this lesion on his forearm ⤵️ Per patient no trauma, it evolve over a period of 2-3 weeks

Think of your Differential Diagnosis as we biopsy his arm……#IDTwitter #MedED #Dermatology
#EmoryID

Biopsy came back suppurative Granulomatous dermatitis and these findings where they saw in the GMS & PAS-stained yeast and hyphal forms #EmoryID #IDTwitter #FungiFriday @GermHunterMD @FungalDoc @josh_nosanchuk @DrFungus_MSGERC

Photos courtesy: Jeannette Guarner, MD

What is your diagnosis? @WuidQ @MayoClinicINFD @UNMC_ID @BCMIDFellowship @RushCCH_ID @IUIDfellowship @BIDMC_IDFellows @YaleIDFellows @MGHBWHIDFellows @ID_fellows ….tick tock 24 hour for the reveal #IDTwitter #EmoryID

Tight race among the top 3 contenders. The answer is…. C Scedosporium let’s see why?
Fig1: Plate shows a cottony and moist white colony with fine short mycelial tufts As it matures in 5 days it will change color from white➡️gray➡️black #EmoryID #FridayFungi #IDTwitter

On to the microscope photos: Dichotomous branching at 60 to 70 angles, septated hyaline cylindrical hyphae, *Conidiogenesis is anellidic, oval, brown, sticky conidia (best seen on GMS) Photos courtesy: Jeannette Guarner, MD
#EmoryID #IDtwitter #FridayFungi Want to know more

✅ out these articles:
1-https://academic.oup.com/mmy/article/56/suppl_1/S102/4925971
2-https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2223844/
Treatment in this pt: a-⬇️steroid (⬆️immune system) b-Voriconazole +/-terbinafine c-Surgical debridment Thoughts? @FungalDoc @GermHunterMD @DrFungus_MSGERC @A_Spallonii #EmoryID #IDTwitter #FungiFriday

Originally tweeted by Laila #WearAMask Woc-Colburn, MD (@DocWoc71) on 21 August, 2020.

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