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Fungal infection should be considered despite negative tissue culture

Deep cutaneous fungal infection should be considered in the differential diagnosis of nonspecific cutaneous lesions with aligning histopathology regardless of a negative skin tissue culture, according to researchers.

The researchers performed a 10-year retrospective review of all histopathologic specimens diagnosed as deep cutaneous fungal infections, along with their corresponding skin culture results, at the Mayo Clinic in Rochester, Minn., between 2003 and 2012. In all, 33 patients were included in the review.

Eight of the 33 skin tissue cultures were negative, despite positive identification of fungal elements on histopathology, according to the researchers. Among these eight patients, three had concurrent positive non-tissue cultures that correlated with the researchers’ interpretation of the pathology, and three died from systemic fungal infection.

“While the incidence of [deep cutaneous fungal infection] in the general population is unknown, it is more common in the immunosuppressed population, occurring in 20% to 30% of organ transplant recipients, with the highest rates noted within the first 2 years post-transplantation,” the researchers wrote.

Disclosure: The authors have no relevant financial disclosures.