Sequential Phialemoniopsis curvata and Botryosphaeria dothidea infections over three years in bilateral lower limbs of a rheumatoid arthritis patient: a case-based review.

BACKGROUND

Rheumatoid arthritis (RA) patients are at increased risk of opportunistic infections due to immune dysregulation and immunosuppressive therapies.

METHODS

A retrospective study describes sequential cutaneous infections caused by Phialemoniopsis curvata and Botryosphaeria dothidea. Mycological examination includes direct microscopy, mycology culture and slide culture of the isolate. Biopsy of the lesion was sent for histopathology and periodic acid-Schiff staining. The PCR product was directly sequenced using both the ITS1 primer and ITS4 primer. Isolate was further identified by scanning electronic microscopy. A literature review was conducted via PubMed and Scopus using keywords related to P. curvata and B. dothidea infections. Clinical, histopathological, and microbiological data from the patient’s case were analyzed, including fungal culture, microscopy, and molecular identification.

RESULTS

The 58-year-old RA patient presented with sequential cutaneous infections caused by Phialemoniopsis curvata and Botryosphaeria dothidea with long-term glucocorticoids and methotrexate, which was confirmed by histopathology, mycology study, PCR sequencing and scanning electronic microscopy. Literature review identified 29 cases, with hematologic involvement and high mortality (25%) in P. curvata infections.

CONCLUSIONS

Immunosuppression is the primary risk factor for infections by environmental fungi like P. curvata and B. dothidea. Hematogenous dissemination correlates with poor outcomes, emphasizing the need for early diagnosis and antifungal therapy. Clinicians should maintain high vigilance for atypical fungal pathogens in RA patients on immunosuppressants.