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Article in Japanese

Catheter-related bloodstream infection caused by Exophiala dermatitidis in a 2-year-old girl

Takahiro SUZUKI1), Takayuki YAMANAKA2), Yuta AIZAWA2), Yuho HORIKOSHI2)

Exophiala dermatitidis is a black fungus that is widely present in the environment. For human infection, it causes mainly skin infections. Although rare bloodstream infections among immunocompromised adults were reported, those in children were not reported in Japan. We hereby reported a pediatric case of catheter-related bloodstream infection with Exophiala dermatitidis. The patient was a 2-year-old girl with short bowel syndrome after surgery of retroperitoneal teratoma. Intravenous hyperalimentation was required through a long-term central venous catheter. She was initially presented with fever and sent home after obtaining blood culture. She was called in for persistent 3 days fever and blood culture grew yeast-like fungi. Our assumption of diagnosis was candidemia at first. As the colonies gradually turned into black with mycelial formation by microscopic examination, Exophiala was suspected. Gene sequencing subsequently identified Exophiala dermatitidis. The patient was treated by administration of liposomal amphotericin B and removal of the central venous catheter. Identifying species of Exophiala is difficult in general laboratories by routine testing. Recognition of black colonies or formation of hyphae would trigger for further molecular investigation of Exophiala species.

1) Department of General Pediatrics, Tokyo Metropolitan Children's Medical Center
2) Division of Infectious Disease, Tokyo Metropolitan Children's Medical Center

Key words Exophiala dermatitidis, fungemia, black fungus, catheter-related bloodstream Infection, child
Received July 27, 2017
Accepted December 22, 2017

30 (1):33─37,2018