A Case of Cutaneous Purpureocillium lilacinum Infection

Purpureocillium lilacinum (formerly Paecilomyces lilacinus) is a saprophytic fungus found in the soil and decaying vegetation and is rarely pathogenic to humans. To our knowledge, only six cases of cutaneous infection caused by P. lilacinum have been reported in journals published by the Korean Dermatological Association and the Korean Society for Medical Mycology. Here, we report the case of a patient with localized cutaneous infection caused by P. lilacinum. An 84-year-old woman presented with a 2-month history of multiple plaques with surrounding erythematous patches on her left forearm and dorsum of the hand. Histopathological examination showed suppurative inflammation accompanied by fungal elements in the dermis. Furthermore, periodic acid-Schiff and methenamine silver staining showed revealed fungal elements. The sub-cultured fungus of the isolate revealed velvety pink colonies that were yellowish-tan on the reverse side, and lactophenol cotton blue staining showed flask-shaped phialides. The DNA sequence from the colony was identical to that of P. lilacinum. The patient was treated with oral itraconazole (200 mg/d) for 6 weeks that achieved significant improvement in the patient's condition.