Pythium species may cause skin and/or subcutaneous lesions alone or in combination with other patterns of infection.
Clinical and pathologic features of subcutaneous pythiosis:
(1) The patient often has risk factors for human pythiosis.
(2) There is a variable chronic swelling in affected areas.
(3) The patient develops painful skin lesions in the form of nodules and/or ulcers.
(4) Some patients may develop a cellulitis.
(5) Biopsy of a lesion shows granulomatous reaction with eosinophils and often the Splendore-Hoepplei phenomenon.
(6) Special stains for fungi show non-septate hyphae.
(7) Specimens placed on fungal media grow in a few days.
(8) The infection does not respond to standard antifungal agents but may respond to prolonged therapy with a saturation solution of potassium iodide (SSKI).
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