SHM Converge Scientific Abstract ePoster Gallery-Cutaneous Protothecosis After Recent Steroid Exposure

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Protothecosis is a rare infection caused by algae from the Prototheca genus, usually seen in animals but occasionally in humans, especially those who are immunocompromised. Human disease can present as cutaneous infection, olecranon bursitis, systemic infection, or disseminated disease. Because bacterial cellulitis is common, atypical infections such as fungal or algal causes should be considered when presumed cellulitis does not improve with standard antibiotics. Early tissue biopsy and culture are important for diagnosis.<br /><br />This case involved a 78-year-old man with COPD who received steroids for a COPD exacerbation and COVID infection. Three weeks later, he developed a right arm rash diagnosed as bacterial cellulitis. Despite 7 weeks of antibiotics and 12 weeks of steroids, the lesion did not resolve. Skin biopsy showed yeast-like forms, and oral itraconazole was started. Culture later identified Prototheca species. He was treated with amphotericin B, which improved the infection but caused renal injury, so therapy was changed to posaconazole. Repeat biopsy and culture still showed infection. Posaconazole was then replaced with oral isavuconazole because of delirium and treatment failure. The infection resolved after 4 weeks of isavuconazole.<br /><br />This report highlights that protothecosis should be considered in refractory cellulitis, particularly in immunocompromised patients, and suggests that oral isavuconazole may be an effective treatment option for cutaneous Protothecosis.

Asset Subtitle

Nathan Arnett

Meta Tag

Author List Jay Anderson, Nathan Arnett, Vivek v. Jasti

Category Clinical Vignettes

Concept Protothecosis

Concept Cutaneous Protothecosis

Concept Cellulitis

Concept Tissue Biopsy

Concept Culture

Distinguished Non-Finalist

Presenter Organization OhioHealth Riverside Methodist Hospital

Presenting Author Nathan Arnett

Track Adult

Keywords

Protothecosis

Prototheca

cutaneous infection

immunocompromised

cellulitis

skin biopsy

culture

itraconazole

amphotericin B

isavuconazole

Protothecosis

Cutaneous Protothecosis

Cellulitis

Tissue Biopsy

Culture