Tibial Osteomyelitis Due to Fonsecaea pedrosoi in an Immunocompetent Patient: Case Report

Dematiaceous fungi are the etiological agents of phaeohyphomycosis. Diverse presentations of infectious syndromes are seen, ranging from local infections after trauma to widely disseminated infection in immunocompromised patients. Fonsecaea pedrosoi species have been reported to cause an increasing number of infections, particularly in severely immunocompromised patients. Colonization of normal skin has been reported. We present a case of F. pedrosoi osteomyelitis in an immunocompetent patient. A high level of suspicion and routine fungal cultures are required to identify these cases. Tissue culture and pathologic examination are necessary for definitive diagnosis and for distinguishing infection from colonization. Therapy includes antifungal drugs (itraconazole) and aggressive surgical debridement, and, even when these modalities are readily implemented, the outcome may not be optimal because of the angioinvasive character of the organism. Level of Clinical Evidence: 4 (The Journal of Foot & Ankle Surgery 48(5):569-572, 2009)