Facial subcutaneous phaeohyphomycosis caused by Phialophora verrucosa: successful treatment with itraconazole and local resection

Introduction: The fungal disease phaeohyphomycosis tends to occur in immunosuppressed individuals and has rarely been reported to be caused by Phialophora verrucosa . Case presentation: Here, we report a primary subcutaneous phaeohyphomycosis case caused by P. verrucosa in an immunocompromised Chinese female with a CARD9 mutation that was cured with local resection and further treated with itraconazole. The current case is placed in perspective with a review of the relevant literature. The patient presented with painless dark erythema and a plaque on the right part of her face that had been present for the past 20 years. Histological examinations revealed multiple brown hyphae, bead‐like pseudohyphae and yeast‐like cells either within the giant cell or distributed in the dermis and subcutaneous tissues. The fungal cultures were morphologically identified as P. verrucosa and were confirmed by internal transcribed spacer region nucleotide sequencing. A partial surgical focal excision was performed, and the patient was treated with oral itraconazole 200 mg daily for 1 year as maintenance therapy, resulting in complete resolution of the lesions. Conclusion: This case is notable due to the prolonged course before a definitive diagnosis was made, the rarity of P. verrucosa as the cause of subcutaneous phaeohyphomycosis and the dramatic improvement after the focal lesion was excised and treated with itraconazole.