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Research Article

Fatal dermatophytic pseudomycetoma in a patient with non-HIV CD4 lymphocytopenia

ORCID Icon, , , , ORCID Icon &
Article: 2208685 | Received 01 Jan 2023, Accepted 26 Apr 2023, Published online: 17 May 2023

Figures & data

Figure 1. Clinical manifestations of the patient. A, B, C, D. Initial lesion; E, F, G, H. after six months of treatment. Red nodules and plaque with a clear boundary on the mandible, neck, extremities and trunk, with some ulcers and pus on the surface.

Figure 1. Clinical manifestations of the patient. A, B, C, D. Initial lesion; E, F, G, H. after six months of treatment. Red nodules and plaque with a clear boundary on the mandible, neck, extremities and trunk, with some ulcers and pus on the surface.

Figure 2. A. Direct microscopy of lesions revealed septate, branched hyphae (Calcofluor-white staining); B. macroscopy of the isolate with poor conidiation (PDA, 14 d, 28°C); C. microscopy of the cultured strain showing irregular hyphae morphologically (lactophenol cotton blue staining); D, E. skin biopsy specimens showing intense inflammatory infiltrates, aggregates of hyaline hyphae in the dermis with infectious granulomata (PAS staining; original magnification × 40 and × 400).

Figure 2. A. Direct microscopy of lesions revealed septate, branched hyphae (Calcofluor-white staining); B. macroscopy of the isolate with poor conidiation (PDA, 14 d, 28°C); C. microscopy of the cultured strain showing irregular hyphae morphologically (lactophenol cotton blue staining); D, E. skin biopsy specimens showing intense inflammatory infiltrates, aggregates of hyaline hyphae in the dermis with infectious granulomata (PAS staining; original magnification × 40 and × 400).

Figure 3. Pro-inflammatory cytokines and adaptive immune responses in PBMCs derived from patients and healthy control individuals. A-C. Pro-inflammatory cytokines (A) TNF-α, (B) IL-1β, and (C) IL-6 in response to 24-h stimulations with LPS, curdlan, Pam3CSK4 and Microsporum canis (HK or viable resting) in supernatants detected by ELISA; D-F. cytokines (D) IL-22, (E), GM-CSF, (F), IFN-γ in response to curdlan and M. canis (HK or resting conidia) stimulation, were measured in cell culture supernatants after 6 d using commercial ELISA kits. LPS, lipopolysaccharide; PBMC, peripheral blood mononuclear cell.

Figure 3. Pro-inflammatory cytokines and adaptive immune responses in PBMCs derived from patients and healthy control individuals. A-C. Pro-inflammatory cytokines (A) TNF-α, (B) IL-1β, and (C) IL-6 in response to 24-h stimulations with LPS, curdlan, Pam3CSK4 and Microsporum canis (HK or viable resting) in supernatants detected by ELISA; D-F. cytokines (D) IL-22, (E), GM-CSF, (F), IFN-γ in response to curdlan and M. canis (HK or resting conidia) stimulation, were measured in cell culture supernatants after 6 d using commercial ELISA kits. LPS, lipopolysaccharide; PBMC, peripheral blood mononuclear cell.

Figure 4. Proportions of lymphocytes and CD4+ T-cells determined by flow cytometry after 6-day stimulation.

Figure 4. Proportions of lymphocytes and CD4+ T-cells determined by flow cytometry after 6-day stimulation.

Data availability statement

All data were shown in Results and supplementary tables.