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Institution: Royal Brisbane and Women's Hospital - Queensland, Australia
We present a rare case of a patient with a non-healing ulcerated wound on her neck post excision of an invasive basal cell carcinoma reconstructed with a split thickness skin graft and received post-op radiotherapy for high risk perineural invasion. The patient had some recent biopsies taken which were sent for histology, acid fast bacilli, fungal and microscopy testing to identify the cause of this non-healing wound. After excluding recurrence of disease, approximately 2 weeks after submission of specimen a rare fungus called Arthrinium Marii grew on the tissue taken. The infectious disease team were consulted who were able to only identify 3 human cases of this specific fungus whereby an anti-fungal was used to treat the infection for 3 months from the “azole” family.
Fungi of the genus Arthrinium was described by Schmidt and Kunze in the early 19th century and to date only 32 species of Arthrinium fungi have been reported. Many species lead a parasitic lifestyle, being facultative plant pathogens. Radiation in itself is a localised risk factor for infection. Therefore it is always important to consider fungal species as a provisional diagnosis for causes of non-healing irradiated wounds whilst excluding any underlying neoplastic disease.
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Authors
Dr Gagandip Sanghera - , Dr Geraldine Lee - , Dr Brendan Louie -