FUNGAL FOOT INFECTION CAUSED BY CYLINDROCARPON SP.: A RARE CASE

Background: Saprophytic soil species-rarely plant or human parasites—are included in the genus Cylindrocarpon. They are recognized as uncommon agents that can cause mycetomas, keratitis, or widespread infections. Although rare, tinea pedis due to Cylindrocarpon sp. was described for the first time in 1985.
Based on theory, the culture results of the Cylindrocarpon species gives an overview colonies on SDA show rapid growth reaching a diameter of 30 mm within 4 days. C. colonies are hyaline or brightly colored, like leather or wool. In our case, the culture grew 5 days after specimen collection but was contaminated, so a re-culture was done from the culture that had grown. Until now, there is no guideline for the treatment of Cylindrocarpon infection in humans, but in general, the treatment of Cylindrocarpon is similar to the treatment of other mold infections.
Case:A 68-year-old woman came to the outpatient clinic of Dermatology and Venereology at RSUD Dr. Soetomo Surabaya complaining of white spots between the toes that were felt since 4 months ago. Complaints were also accompanied by complaints of itching. The patient had a habit of walking on the ground barefoot. The patient's
dermatologic status at March 15th, 2022 revealed multiple white macules with indistinct border, maceration, erosion, without any scale at interdigiti 4 and 5 pedis dextra and interdigiti 1 and 4 pedis sinistra region. Direct microscopic examination using potassium hydroxide of the lesion scrapings revealed the presence of hyphae. The patient was diagnosed with tinea pedis interdigitalis type. Patient revisited the hospital after 1 week (2nd visit). The lesions at the webspaces did not get any better. At the third visit, the patient said the lesion felt slightly reduced but not significant. It
was also felt that the white lesions on the legs were not increasing.
Results:The results of KOH examination taken from the culture results gave a picture of macroconidia consisting of one to several septate, hyaline, straight, cylindrical to fusiform, with a rounded top and flat base, hyaline chlamydospores, spherical, formed singly, in chains or groups, intercalated or terminal. The fungal species was identified as
Cylindrocarpon sp. Due to the change in the patient's diagnosis to fungal foot infection caused by Cylindrocarpon sp. then the patient's therapy was adjusted and the griseofulvin drug previously given was changed to itraconazole tablets 200mg twice daily and cetirizine 10mg once daily. At the 7th week visit, our patient said the lesion felt slightly increased and there was a wound on the lesion. The culture results showed a colony picture in the form of fast growing colonies, hyaline or brightly colored, like wool and the back of the fungal colonies showed a reddish brown pigmentation color.
Conclusion:The starting point of treatment for superficial or localized tinea pedis is topical antifungal medication. If the patient has impaired immune function, the condition is extensive, recurring, chronic, or resistant to topical antifungal treatment, or there is evidence of concurrent onychomycosis, systemic treatment should be taken into consideration.