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Diagnosis of Deep Seated Cutaneous Mycoses (DSCM) – Practical Exemplification of Current State of Art
Cristiana Popp *, Sabina Zurac *, Razvan Andrei *, Tiberiu Tebeica*, Florica Staniceanu*, Virginia Chitu*, Cleo Rosculet**, Adrian StreinuCercel**
*Colentina University Hospital
**„Matei Balș” National Institute of Infectious Diseases
DSCM are rare lesions occurring in imunosupressed patients, sometimes with critical evolution due to multiple factors including
immune status, associated diseases and poor therapy response. That emphasizes the importance of early and accurate
diagnosis despite the confounding clinical and histopathological aspects. Keys of diagnosis are the high level of susceptibility
and patient’s multidisciplinary approach.
No
Age/Sex
Localization
Cause of immunosupression
Pathological findings
Fungi
appearance
Fungi type
Evolution
1
42/F
Forearm
Corticotherapy for LE
Giant-cell inflammation with
polymorphous inflammatory
cells and suppurative and
necrotic areas
Spores of 5-15µ &
spherules with
endosporulation
Coccidioidossis
Good
2
62/F
Periocular
Diabetes mellitus
Suppurative necrosis;
important polymorphous
inflammatory infiltrate;
impressive vascular
invasion
Broad, thin-walled,
hyaline, aseptate
hyphae; irregular
branching
Mucormycosis
Sepsis,
death
3
33/M
Forearm
None, after DSCM
diagnosis, he tested
positive for HIV
Dermal inflammatory
infiltrate with numerous
histiocytes with foamy
cytoplasms
Small, mildly
pleomorphic yeasts
with narrow-based
buds, melanin +; no
hyphae
Criptoccocosis
Difficult
4
64/F
Pretibial
Corticotherapy for RP
Granulomatous
inflammatory infiltrate with
suppurative foci
Short, septated,
dichotomously
branched hyphae,
rare yeasts
Aspergillosis
(second biopsy)
Very good
5
56/M
Arm
Postirradiation
Ischemic dermal necrosis
Numerous septated
hiphae and rare
yeasts
Aspergillus &
Candida
Difficult
Case 1
HE
PAS
Case 2
HE
Grochott
The fungal elements are rather inconspicuous in HE stain.
Very important for diagnosis is the routine examination of at least one fungal stain for each inflammatory cutaneous lesion in
immunosupressed patients (PAS, Grochott)
HE
HE
PAS
Grochott
Grochott
PAS
Case 3
HE
HE
Grochott
Case 4
Case 5
Grochott
Protocols of British Society for Medical Mycology
The pathologist is not called to establish the exact type of fungi, the pathological report must include:
 the presence and absence of yeast forms,
 the presence and absence of hyphae,
 whether hyphae are septate or aseptate,
 presence of melanin,
 the size of fungi,
cellular location
 any specialised structures
The appearance of fungi can be sufficient to
guide treatment, but the golden standard
requires
either
immunohistochemical
confirmation of the specific type or confirmatory
cultures.
Patients with poor immune status
have, usually, a long, difficult
evolution,
with
possible
fatal
outcome
due
to
systemic
dissemination of fungal infection.
HE
Bronchopneumonia (case 2)
Applying these standards in routine examination of inflammatory skin biopsies micotic infection can be identified as cause of
inflammation, thus improving management of immunocompromised patients.