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Background: Hyalohyphomycosis is a rare opportunistic fungal infection caused by saprophytes of genera such as Fusarium, Paecilomyces, Scedosporium, Penicillium, Scopulariopsis Acremonium, and similar fungi. The literature includes only one previous report of Paecilomyces variotii human infection and very few reports of subcutaneous mycosis caused by any of the hyalohyphomycosis group of fungi., Methods: We report an instance of fungal infection in a 50-year-old woman, known to have diabetes, who presented with multiple raised lesions on the upper back of two years' duration. Dermatological examination revealed a 20 × 22-cm, swollen, indurated area on the upper back with multiple violaceous, exophytic nodules on the surface., Results: Microscopy from pus and tissue smear revealed septate branching fungi. Periodic acid Schiff (PAS) stain was positive for fungal elements. Culture on three occasions yielded P. variotii. Slide culture mounts showed septate hyaline hyphae of P. variotii with elongated phialides demonstrating bulbous bases and tapering apices attached to the conidiophores. The patient was treated with itraconazole, to which she responded well., Conclusions: This is the first reported case of subcutaneous hyalohyphomycosis caused by P. variotii. It appears that this relatively rare fungal pathogen may be starting to assert itself as an important cause of infection in humans., (© 2013 The International Society of Dermatology.)

Cutaneous infection with Paecilomyces lilacinus is encountered worldwide, with most infections occurring either iatrogenically or in immunocompromised hosts. We report three cases of cutaneous hyalohyphomycosis caused by P. lilacinus, one of which occurred in an immunocompetent individual. In addition, we review the 17 cases previously reported in the literature. Although this infection can be difficult to treat, most cases are not fatal. Most cases responded well to systemic azole antifungal agents, either alone or in association with surgical excision of the lesion. Paecilomyces species are saprophytic fungi found in soil and decaying organic matter. Infection in humans is rare, but when it occurs treatment is often difficult. We report three cases of cutaneous hyalohyphomycosis caused by P. lilacinus and review the 17 previously reported cases in which the clinical history and response to therapy were described.