Division of Dermatology, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Mycology Section, "Dr. Manuel Gea Gonzalez" General Hospital, Mexico City, Mexico.
Mycoses. 2024 Oct;67(10):e13805. doi: 10.1111/myc.13805.
Tropicoporus tropicalis (formerly Phellinus tropicalis) is a saprophytic basidiomycete that has been implicated in refractory mycoses in humans, particularly in patients with chronic granulomatous disease. Despite its clinical significance, T. tropicalis is an under-recognised cause of eumycetoma, with no prior reports available. We present a case of white grain eumycetoma with associated osteomyelitis of the left foot, caused by T. tropicalis, confirmed through 18S-ITS1-5.8S-ITS2-28S rRNA gene amplification and sequencing. The patient was treated with itraconazole 200 mg daily, leading to gradual improvement. A review of the literature on T. tropicalis infections in humans reveals its characteristic manifestations, which include osteomyelitis, soft tissue abscesses, pulmonary nodules and keratitis. These infections are locally destructive but have the potential to disseminate. Diagnosis is often delayed and relies on molecular techniques. Amphotericin B combined with an azole appears to be the most effective treatment, often necessitating concurrent surgical drainage. In conclusion, T. tropicalis is a newly recognised pathogen associated with eumycetoma and poses an increased risk of osteomyelitis. Molecular identification, such as sequencing the internal transcribed spacer (ITS) region from cultures or tissue specimens, is crucial for accurate identification of this pathogen.
热带多孔菌（原名热带拟层孔菌）是一种腐生担子菌，已被牵连到人类的难治性真菌感染中，特别是在慢性肉芽肿病患者中。尽管具有临床意义，但 T. tropicalis 是一种被低估的真菌性足菌肿的原因，目前尚无相关报道。我们报告了一例由 T. tropicalis 引起的左足白色颗粒状真菌性足菌肿伴骨髓炎的病例，通过 18S-ITS1-5.8S-ITS2-28S rRNA 基因扩增和测序得到确认。患者接受了伊曲康唑 200mg 每日治疗，病情逐渐改善。对 T. tropicalis 感染人类的文献进行回顾，揭示了其特征性表现，包括骨髓炎、软组织脓肿、肺结节和角膜炎。这些感染具有局部破坏性，但有传播的潜力。诊断常常被延误，依赖于分子技术。两性霉素 B 联合唑类药物似乎是最有效的治疗方法，通常需要同时进行手术引流。总之，T. tropicalis 是一种新发现的与真菌性足菌肿相关的病原体，增加了骨髓炎的风险。分子鉴定，如对培养物或组织标本的内部转录间隔区（ITS）区域进行测序，对于准确识别这种病原体至关重要。
