Fusarium species may cause a variety of skin infections ranging from onychomycosis in healthy hosts to widely disseminated lesions in immuno­compromised patients with hematogenously disse­minated multiple organic infections. A variety of skin infections accompany Fusarium infections including red or gray macules or papules, which progress to central ulceration or eschar formation, purpuric papules, pustules, and subcutaneous nodules. The lesion most characteristic of Fusarium infection is a red or gray macule with a central ulceration of black eschar. Healing lesions may progress to an eschar surrounded by concentric scales. Patients with cutaneous disease related to Fusarium species can present with superficial and deep infections. In addition, Fusarium species may colonize wounds, burns, and chronic ulcers.

As reported in a recent review of cutaneous infections by Fusarium species, immunocompetent patients more frequently had a history of skin breakdown than those who were immunocom­promised. In our patient, the predisposing cutaneous ulcer due to ASO seems to be a good condition for the growth of that fungus. Our patient had nothing predisposing him to opportunistic infection. In immunocompetent patients, Fusarium species should not be able to spread because they are usually well walled-off. Fusarium species that directly invade through traumatized skin would usually spon­taneously resolve, but in our patient the infection did not initially respond to the itraconazole pulse therapy. After correction of the vascular insu­fficiency, ulcerative lesions improved rapidly. It seems that predisposing skin breakdown as caused by trauma, severe burn, foreign body, or vascular insufficiency is the risk factor for Fusarium infection. Therefore, detection and correction of the underly­ing cause will be essential in Fusarium infection in immunocompetent patients.
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The diagnosis of Fusarium infection is principally based on mycology and histopathology. Recently, a PCR technique has also been developed for specific detection of Fusarium species from both culture and clinical samples. Cultures require incubation at 2 5°C on a Sabouraud dextrose agar without cyclo- heximide. The most important microscopic features for species identification on culture are the conidia: the presence of fusoid macroconidia, which have foot cells with some type of heel, is accepted as the most definitive characteristic of the genus Fusarium. Histologically, diagnostic clues include the presence of adventitious sporulation consisting of phialides and phialoconidia and the presence of irregular hyphae with both 45- and 90-degree branching in a closed lesion.
Fusarium species are resistant to several che- motherapeutic agents, and treatment using these drugs has frequently failed in immunocompromised patients. But Fusarium infections in immunocom­petent patients generally exhibit a good response to therapy. Superficial Fusarium infections usually respond to local treatment, systemic ketoconazole and/or debridement. Localized deep infection may respond to surgical resection of infected tissue, amphotericin В alone or combined with surgical and medical treatments.

In summary, we presented a case of infection by Fusarium solani associated with ASO in an otherwise healthy man. This case may contribute to the recognition of Fusarium infection in immunocom­petent patients. It also showed that a Fusarium infection could occur in a cutaneous ulcer of the ASO. Since the predisposing skin breakdown will be the risk factor for Fusarium infection, dermatologists must consider the possibility of underlying causes such as vascular insufficiency when Fusarium in­fection is unresponsive to conventional treatments, especially in immunocompetent patients. suhagra